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Molecular Diagnosis and Risk Prediction in BK Virus Nephropathy: Discovery and Multicenter Validation of Novel Intragraft Gene Expression Signatures

B. Adam1, Z. Kikic2, Y. Bouatou3, J. Gueguen3, B. Robin3, G. Reid1, H. Regele2, M. Rabant3, A. Loupy3, M. Mengel1

1University of Alberta, Edmonton, AB, Canada, 2Medical University of Vienna, Vienna, Austria, 3Paris Transplant Group, Paris, France

Meeting: 2020 American Transplant Congress

Abstract number: 495

Keywords: Biopsy, Kidney transplantation, Polyma virus, Rejection

Session Information

Session Name: Kidney: Polyoma

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 4:03pm-4:15pm

Location: Virtual

*Purpose: Novel tools are needed to improve diagnosis and risk prediction in BK virus nephropathy (BKVN). This study aimed to assess the utility of intragraft gene expression for this purpose.

*Methods: NanoString was used to assess differential gene expression between native kidney biopsies with BKVN (n=5) and renal allograft biopsies with pure T-cell mediated rejection (TCMR, n=10). Candidate gene sets were then evaluated in a cohort representing a spectrum of BK infection (n=25), followed by a separate multicenter validation cohort of renal allograft biopsies with BKVN (n=60) or TCMR (n=10). Diagnostic performance and correlation between gene set expression, histology and clinical outcome were assessed.

*Results: Five polyomavirus (PV) genes and 7 immune genes were significantly differentially expressed between native BKVN and pure TCMR (Fig. 1). PV 5-gene set expression demonstrated excellent distinction between BKVN and TCMR (validation cohort ROC AUC=0.992, p<0.0001) (Fig. 2) and correlated with Banff pvl-score (rho=0.443, p=0.0004) and PVN class (rho=0.345, p=0.007). Immune genes (5 associated with BKVN and 2 with TCMR) had inferior diagnostic performance (validation AUC=0.720 and 0.633, respectively). Within the validation cohort, no significant differential expression was identified between BKVN patients with resolution (n=35), persistence (n=14) and de novo rejection (n=11) at 6 months post-biopsy (Fig. 3). However, TCMR-immune 2-gene set showed higher expression in persistence vs. resolution (p=0.0005) and rejection (p=0.001).

*Conclusions: These data suggest that intragraft gene expression can improve diagnosis and risk prediction in BKVN.

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To cite this abstract in AMA style:

Adam B, Kikic Z, Bouatou Y, Gueguen J, Robin B, Reid G, Regele H, Rabant M, Loupy A, Mengel M. Molecular Diagnosis and Risk Prediction in BK Virus Nephropathy: Discovery and Multicenter Validation of Novel Intragraft Gene Expression Signatures [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/molecular-diagnosis-and-risk-prediction-in-bk-virus-nephropathy-discovery-and-multicenter-validation-of-novel-intragraft-gene-expression-signatures/. Accessed May 10, 2025.

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