ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

Metastatic BK Virus-Associated Urothelial Carcinoma Originating in Renal Allograft

J. Torrealba1, H. Jones1, A. Bhakta2, L. Jia1, D. Wojciechowski2

1Pathology, UT Southwestern, Dallas, TX, 2Internal Medicine, UT Southwestern, Dallas, TX

Meeting: 2022 American Transplant Congress

Abstract number: 1504

Keywords: Kidney, Malignancy, Polyma virus

Topic: Clinical Science » Organ Inclusive » 67 - Non-PTLD/Malignancies

Session Information

Session Name: Non-PTLD/Malignancies

Session Type: Poster Abstract

Date: Monday, June 6, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Cases of urinary tract carcinoma associated with BK virus have been reported in kidney transplant recipients; therefore, we postulate that BK virus may play a role in oncogenesis.

*Methods: Here we present a report of BK virus-associated urothelial carcinoma originating in the renal allograft with concurrent metastases in multiple sites.

*Results: A 32-year-old male received living related donor kidney transplant in 2007, with baseline creatinine at ~1.7-1.9 mg/dL and an immunosuppression regimen including tacrolimus, mycophenolate, and prednisone. In March 2021, he developed hematuria. Subsequent imaging studies showed a 2.3 cm FDG-avid exophytic mass at the transplant kidney and concurrently, FDG-avid masses in bilateral lungs, lymph nodes, and pancreatic head. Within 3 months, he developed BK viremia (>26,000 copies/mL), which worsened (~38,500 copies/mL) despite immunosuppression reduction. Further immunosuppression reduction and the addition of IVIG and leflunomide showed no improvement. When he developed markedly elevated creatinine (~8 mg/dL), allograft biopsy showed mild acute T-cell-mediated rejection. Further reduction of immunosuppression improved viremia (3,566 copies/mL). CT-guided biopsies of renal allograft mass and lung nodule demonstrated urothelial carcinoma with BK virus positive immunolabeling using SV40 immunostain as a surrogate marker. Transplant nephroureterectomy revealed invasive high-grade urothelial carcinoma with extensive necrosis (~70%), invading renal pelvis and renal parenchyma. Regional lymph nodes were involved by tumor. Both BK virus and p53 overexpression were confined to in-situ (Figure 1, parts A-C) and invasive (Figure 1, parts D-F) urothelial carcinoma and absent in benign urothelium.

$$graphic1

Figure 1. Allograft nephroureterectomy (10x).

*Conclusions: There are some reports of BK virus-associated carcinomas of the bladder and kidney arising in renal transplant patients, however, this case is unique in arising from the allograft kidney and displaying aggressive behavior with locally advanced disease and distant metastases. Furthermore, animal models have shown BK virus to be oncogenic in renal tissue, and proposed this oncogenic model involves T-Ag protein binding to and thus inactivating RB proteins and TP53.

  • Tweet
  • Email
  • Print

To cite this abstract in AMA style:

Torrealba J, Jones H, Bhakta A, Jia L, Wojciechowski D. Metastatic BK Virus-Associated Urothelial Carcinoma Originating in Renal Allograft [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/metastatic-bk-virus-associated-urothelial-carcinoma-originating-in-renal-allograft/. Accessed May 9, 2025.

« Back to 2022 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences