Session Name: Kidney: Polyoma
Session Date & Time: None. Available on demand.
*Purpose: Polyomavirus BK (BKV) reactivation or transmission is a wellknown problem in renal transplant (TX) patients with BKV nephropathy and interstitial cystitis. The role of BKV-associated urothelial carcinoma is still debated.
*Methods: We reviewed the clinical data of five patients with BKV-associated urothelial carcinoma to understand the difference of this severe late complication of renal and extrarenal TX compared to usual BKV-related problems in renal TX patients.
*Results: Between 2014 and 2020, we saw five patients (three men and two women aged 49±17 yrs at TX) with urothelial carcinoma after renal (n=2) and extrarenal TX (heart 1, lung 1, and combined heart-lung 1). Basal immunosuppression consisted in tacrolimus, mycophenolate mofetil (MMF), and prednisolone (Predni) in 3 patients, and everolimus, MMF, and Predni as well as cyclosporine and Predni in 2 other patients. All patients had high viremia (n=5; maximum 596286±444272 copies/mL) and high viruria (n=4; maximum 7.5±5 billion copies/mL; one patient not tested) 4 to 7 years before diagnosis of urothelial carcinoma. Four of 5 patients had had BKV nephropathy 3 to 58 months after TX. Urothelial carcinoma was diagnosed 102±27.2 (71-144) months after TX. Three tumors were located mainly in the bladder, one in the TX ureter, one in both. All had carcinoma metastasis in the lymph system, 3 had also other meststases. Tumor histology was undifferentiated and grade 3 in all cases and showed distinct nuclear SV40 staining of the tumor cells. Cystectomy was performed in 3 cases, TX-ureterectomy in one renal TX and both in the other renal TX patient. Three patients died by metastatic tumor 3, 7, and 26 months after diagnosis. Two patients are alive 36 and 6 months after tumor diagnosis.
*Conclusions: BKV-associated urothelial carcinoma is a late phenomenon after renal and extrarenal TX. Diagnosis occurs often delayed and at an advanced stage, since BKV problems mostly happen up to two years after renal and only rarely after extrarenal TX; therefore BKV testing usually is not done routinely late after renal and in general rarely done at all after extrarenal TX. Prognosis therefore is poor. Diagnosis may be suspected in cases of persisting high viruria, especially after preceding BKV nephropathy earlier.
To cite this abstract in AMA style:Schwarz A, Schmitz J, Gottlieb J, Bara C, Haller H, Braesen J. BKV-Associated Urothelial Carcinoma in Patients After Renal and Extrarenal Carcinoma [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/bkv-associated-urothelial-carcinoma-in-patients-after-renal-and-extrarenal-carcinoma/. Accessed June 16, 2021.
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