An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy

S Kuppachi; D Holanda; M Eberlein; B Alexiev; A J Tyler; M C Wissel; S B Kleiboeker; C P Thomas

doi:10.1111/ajt.14057

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An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy

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An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy

S Kuppachi, D Holanda, M Eberlein, B Alexiev, A J Tyler, M C Wissel, S B Kleiboeker and C P Thomas

American journal of transplantation, Vol.17(3), pp.813-818

03/2017

DOI: 10.1111/ajt.14057

PMID: 27647675

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Abstract

We report a lung transplant recipient who developed BK polyoma virus (BKPyV) DNAemia and BKPyV nephropathy. With careful management of his immunosuppression he achieved significant reduction in BKPyV DNAemia and stabilization of his kidney function. He later developed a high-grade bladder cancer and shortly thereafter he experienced a major upsurge in the level of BKPyV DNAemia that coincided with the discovery of hepatic metastasis. Retrospectively, the bladder cancer and the hepatic secondary tumor stained uniformly for SV40 large T antigen, and the BKPyV DNA sequences identified in plasma corresponded to BKPyV DNA within hepatic tissue, indicating that the spike in BKPyV load was likely derived from the circulating tumor cells or cell-free tumor DNA following metastases of a BKV-associated cancer. To the best of our knowledge, this is the first description of a surge in BKPyV load in a patient with controlled BKPyVN that heralded the appearance of a metastatic urothelial malignancy. This report discusses the literature on BKPyV-associated malignancies and the possibility that unexplained increases in BKPyV DNAemia may be a biomarker for metastatic BKPyV-related urothelial cancer.

Immunosuppression

Polyomavirus Infections - complications

Prognosis

Pulmonary Disease, Chronic Obstructive - surgery

Tumor Virus Infections - virology

Humans

Risk Factors

Urinary Bladder Neoplasms - etiology

Pulmonary Disease, Chronic Obstructive - virology

Graft Rejection - etiology

Graft Survival

Male

BK Virus - pathogenicity

Lung Transplantation - adverse effects

Transplant Recipients

Viral Load

Tumor Virus Infections - complications

Virus Replication

Polyomavirus Infections - virology

Urinary Bladder Neoplasms - pathology

Aged

Graft Rejection - pathology

Details

Title: Subtitle: An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy
Creators: S Kuppachi - Division of Nephrology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
D Holanda - Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA
M Eberlein - Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
B Alexiev - Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
A J Tyler - Viracor-IBT Laboratories, Lee's Summit, MO
M C Wissel - Viracor-IBT Laboratories, Lee's Summit, MO
S B Kleiboeker - Viracor-IBT Laboratories, Lee's Summit, MO
C P Thomas - Graduate Program in Molecular and Cellular Biology, University of Iowa Carver College of Medicine, Iowa City, IA
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.17(3), pp.813-818
DOI: 10.1111/ajt.14057
PMID: 27647675
NLM abbreviation: Am J Transplant
ISSN: 1600-6143
eISSN: 1600-6143
Publisher: United States
Language: English
Date published: 03/2017
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Stead Family Department of Pediatrics; Pathology; Obstetrics and Gynecology; Internal Medicine
Record Identifier: 9983985905402771

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