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

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)813-818
Number of pages6
JournalAmerican Journal of Transplantation
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2017

Keywords

  • cancer/malignancy/neoplasia
  • clinical research/practice
  • complication: infectious
  • disease pathogenesis
  • immunosuppressant
  • immunosuppression/immune modulation
  • infection and infectious agents
  • kidney transplantation/nephrology
  • lung transplantation/pulmonology
  • other
  • viral: BK/JC/polyoma

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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