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As the number of potential kidney transplant recipients exceeds the available organs, there is tremendous focus on reducing allograft discard rates and increasing the number of living donors. There are 107,000 people on the kidney transplant waiting list in the United States, with around 30,000 transplants performed annually in the United States. Approximately 95,000 kidney transplants have been performed worldwide, most of them in North America and Europe. At the same time, there was an initiative to promote the possibility of transplants through education and awareness campaigns. These programs are needed to support the overall goal of graft availability to those who are medically eligible. Because transplantation is such a limited resource, work on maintaining / extending allograft survival should be equally important in filling the gap in people waiting for transplantation and allograft availability.
Polyomavirus BK Nephropathy (PVBKN) is a difficult problem in transplantation. While PVBKN has an incidence of less than 10% of transplant recipients, it can lead to significant graft loss due to rejection episodes and difficulty in clearing the virus https://doi.org/10.1111/ajt.14314. Early detection of the virus can provide a window for immunosuppression reduction and the possible use of antiviral agents to allow preservation of the allograft.
Nil et al. In a recently published study looking at the use of immunohistochemical studies of biopsies to improve the diagnosis of PVBKN, the histopathological assessment, the gold standard, detects nuclear viral inclusion bodies. The addition of immunohistochemical staining for SV40 captured additional cases of PVBKN that were not found to have the classic pathological changes. It was believed that these cases were identified earlier in the development of the PVBKN.
Non-invasive testing has not provided a consistent reliable means of diagnosis because the degree of viraemia and viruria may not correlate with the disease. Given that most allograft dysfunction cases are assessed by kidney biopsy, and the addition of immunohistochemical staining for SV40 is widespread and inexpensive, this seems like an approach that should be adopted as routine by transplant centers. This may be more doable than monitoring the screening for viruria or viraemia over many years, as the potential for PVBKN exists many years after the transplant. Another important factor is that many transplant recipients may not be monitored by transplant nephrologists or transplant centers for routine care, and may not receive monitoring blood and urine screening due to cost or resource availability. The ability to provide early diagnosis and intervention to maintain allograft function, even in a few cases, would be valuable for the long-term maintenance of allografts. This study highlights the need to continue efforts to improve allograft survival and to identify cost-effective interventions that many centers can easily integrate. Constant dissemination of good practice is another important part of improving care.
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