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Table 1 Summary of all reported cases of BK virus-associated nephropathy in lung transplant recipients including the present case

From: BK virus-associated nephropathy in a lung transplant patient: case report and literature review

Author and year Age at transplant
Gender
Indication for transplant Onset of renal dysfunction (months post-transplant)
Creatinine at disease onset (μmol/l)
BKV PCR in urine and blood at diagnosis Biopsy Management Outcome
Schwarz et al. 2005 [15] 38 years
Male
Pulmonary fibrosis due to chemotherapy for seminoma 15 months
227 μmol/l
Urine: +
>  100,000,000 Geq/ml
Blood: +
117,500 Geq/ml
Positive Immunosuppression not reduced due to recent rejection, hence cidofovir used, then leflunomide in place of cidofovir due to improved biopsy results Repeat renal biopsy performed three months after original diagnostic biopsy and one month after a course of cidofovir showed absence of BKVAN changes (with BKV PCR in blood also showing significant reduction) with further subsequent improvement on leflunomide, however renal function nonetheless deteriorated and RRT was required
Egli et al. 2010 [16] 67 years
Female
COPD 63 months
183 μmol/l
Urine: +
> 100,000,000 Geq/ml
Blood: +
71,000 Geq/ml
Positive ↓ immunosuppression, leflunomide (but was ceased at 3 months for diarrhoea / anaemia) Stabilisation of creatinine (peak was at 237 μmol/l improving to 190 μmol/l) and undetectable BKV PCR in blood (still positive in urine) at 1 year post-diagnosis
Dufek et al. 2013 [17] 8 years
Male
Bronchiolitis obliterans 12 months
N/A
Urine:
>  100,000,000 Geq/ml
Blood: +
> 100,000,000 Geq/ml
Positive Haemodialysis, switch of mycophenolate for everolimus, ↓ tacrolimus and prednisolone, intravenous cidofovir Development of rapidly progressive, ultimately fatal, collecting duct carcinoma with strong positivity for SV40 antibody staining in the nuclei of tumour cells
Sharma et al. 2013 [18] 30 years
Male
Cystic fibrosis 24 months
195 μmol/l
Urine: N/A
Blood: +
3,500,000 Geq/ml
Positive Leflunomide commenced and mycophenolate ceased Increase then stabilisation of creatinine at 274 μmol/l at 20 months post-diagnosis
Vigil et al. 2016 [19] 70 years
Male
IPF 24 months
265 μmol/l
Urine: N/A
Blood: +
10,000,000 Geq/ml
Positive Mycophenolate was ceased, tacrolimus and prednisolone continued, leflunomide started and three doses of IVIG given Improvement in BKV PCR in blood and stabilisation of creatinine at 250 μmol/l
Kuppachi et al. 2017 [20] 63 years
Male
COPD 24 months
230 μmol/l
Urine: N/A
Blood: +
87,900 Geq/ml
Positive Azathioprine ceased, ↓ tacrolimus, leflunomide commenced Initial good response with reduction in BKV PCR in blood and stabilisation of renal function at 265 μmol/l, but then was found to have locally-advanced prostate carcinoma and separate metastatic urothelial carcinoma (two separate primary malignancies) which rapidly advanced in parallel with drastic increases in BKV PCR counts
Okumura et al. 2019 [21] 30 years /
44 years
Female
LAM/relapsed LAM 3 months
66 μmol/l
Urine: +
> 100,000,000 Geq/ml
Blood: +
800 Geq/ml
N/A ↓ immunosuppression to standard maintenance levels post-transplant, and addition of sirolimus at six months post-transplant Gradual improvement in renal function and reduction in BKV PCR in blood, with levels falling to undetectable levels at 5 months post-diagnosis
Present case
2020
57 years
Male
COPD 9 months
184 μmol/l
Urine: +
>  10,000,000 Geq/ml
Blood: +
358,000 Geq/ml
Positive ↓ immunosuppression, change of mycophenolate to everolimus, and then IVIG when renal function deteriorated further Gradual deterioration in renal function despite these measures, requiring fistula formation for the planned commencement of haemodialysis
  1. Legend for Table 1: table summarising the eight reported cases of BKVAN in lung transplant recipients. BKVAN BK virus-associated nephropathy. BKV BK virus. PCR Polymerase chain reaction. Geq/ml Genome equivalents per millilitre. RRT Renal replacement therapy. COPD Chronic obstructive pulmonary disease. N/A Information not available from publication. SV40 Simian virus 40. IPF Idiopathic pulmonary fibrosis. IVIG Intravenous immunoglobulin. LAM Lymphangioleiomyomatosis