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Urine cytology screening for polyoma virus infection following renal transplantation: the Oxford experience

¹ Department of Pathology, National University of Singapore, National University Hospital, Singapore
² Department of Microbiology, John Radcliffe Hospital, Oxford, UK
³ Renal Transplant Unit, Churchill Hospital, Oxford, UK
⁴ Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK

Correspondence to:
Ian S D Roberts
Department of Cellular Pathology, John Radcliffe Hospital, Oxford OX3 9DU, UK; ian.roberts{at}orh.nhs.uk Objective: To review the first year of a monthly urine cytology screening service, introduced to identify renal transplant patients at risk of polyoma virus nephropathy (PVN), at an early, potentially treatable, stage.

Methods and results: Monthly urine samples (n = 392) were received from 97/108 transplant recipients in 2005. Of 56 patients with follow-up >6 months, 20% and 9% had significant (>10 decoy cells/cytospin) and non-significant positive cytology, respectively. The first positive urine samples occurred most commonly in the second and third month post-transplantation and patients with significantly positive samples had higher 3-month and 6-month serum creatinine levels than patients with negative urine cytology (p<0.01). Four patients with positive urine cytology had a subsequent positive plasma BK virus PCR; 3/97 patients had biopsy-proven PVN, all in the third month, 1–6 weeks after first positive urine samples.

Conclusions: Significant PV viruria is common following renal transplantation with onset usually within the first 3 months. Viruria is associated with worse graft function at 3 and 6 months. The time between urine positivity and clinical PVN is short. More frequent early urine screening would be required to achieve clinical benefit.