Avaliação retrospectiva e transversal de pacientes transplantados renais associando os poliomavírus BKPyV e JCPyV com a evolução do enxerto

Abstract

Introduction: Polyomaviruses are considered ubiquitous viruses in the population, remaining in a latency state in several tissues. In immunocompromised individuals, viral reactivation may occur, with progressive multifocal leukoencephalopathy mainly associated with JC polyomavirus (JCPyV) and ureteral stenosis, hemorrhagic cystitis and chronic graft nephropathy (NCE) being the main clinical manifestations associated with BKPyV polyomavirus. Early diagnosis is the key in order to prevent the evolution of the infection. Several diagnostic tests have been developed, but still without a well-established standardization. BKPyV is considered an emerging pathogen in renal transplantation and is strongly related to the genesis of NCE. Objective: To perform a retrospective and cross-sectional evaluation of renal transplanted patients associating BKPyV and JCPyV polyomavirus with graft evolution. Methodology: We assessed 247 kidney transplants at two moments, a retrospective study from 2013-2014 (n=155) and a cross-sectional observational study (n=92). For viral determination, the Semi-Nested Polymerase Chain Reaction technique was used. The relationship between viral infections and hematological and biochemical parameters was assessed. The presence of decoy cells in urine was evaluated by urinary cytology, as well as the association of BKPyV with the development of rejection (acute or chronic) and NCE. Results and discussions: There was a low association between the positivity of decoy cells in urine and BKPyV infection. Patients with viremia for BKPyV presented high levels of plasma urea and decreased values of global leukocytes. The highest frequency of patients in the study were true negative for BKPyV (60%), with rare cases of rejection (acute or chronic) and without the development of NCEN and this relationship showed a good sensitivity (82.8%). The results for JCPyV showed no significant differences. After regression analysis, only plasma creatinine levels, post-transplant rejection rates and cytomegalovirus viral infection remained independently associated with the development of NCE. Conclusions: The diagnostic tests used in the study were more sensitive than specific and BKPyV infection was able to influence renal and hematological function of the patients evaluated. Keywords: BK Virus. JC Virus. Rejection. Renal transplantation. Nephropathy.