Urine CXCL10 to Assess BK Polyomavirus Replication After Kidney Transplantation.
Haller, J., et al.Transplantation 2023 [record in progress].
Aims
This secondary analysis of a randomised controlled trial (RCT) aimed to assess levels of urine CXCL10 at different stages of BK polyomavirus (BKPyV) reactivation and to determine the predictive ability of urine CXCL10 for BKPyV replication.
Interventions
Participants in the original trial were randomly assigned to either the intervention arm where elevated levels of urine CXCL10 indicated the performance of a renal allograft biopsy with therapeutic adaptations based on the result; and the control arm, where the results of the urine CXCL10 analyses was concealed.
Participants
235 adult kidney transplant recipients from the original trial were included.
Outcomes
The outcomes of interest included urine CXCL10 levels at different stages of BKPyV infection, urine CXCL10 levels at different phases of patients with BKPyV DNAemia and diagnostic performance of urine CXCL10 for detecting BKPyV replication.
Follow-up
1 year
CET Conclusions
This post-hoc analysis of an RCT investigated the predictive value of urine CXCL10 levels in the diagnosis of BK viral replication. CXCL10 levels were associated with risk of viruria, presence of decoy cells and viraemia. Negative predictive value was high (96%) with an AUC of 0.79, although positive predictive value was low (21%) meaning that the test is not very specific. These findings suggest that urine CXCL10 monitoring may be a useful strategy to rule out significant BK virus infection in transplant recipients. It is worth noting that the investigators selected patients without recent acute rejection episodes, and the test is not specific enough to differentiate between rejection and BK viral infection, meaning that confirmatory tests would be required. The actual clinical benefit of CXCL10 monitoring would need to be confirmed in a prospective RCT.
Trial registration
ClinicalTrials.gov - NCT03140514