@entity8999 XXXX diagnosis and treatment: experience at the University of Maryland Renal Transplant Program.

@entity1 @entity8 @entity8999 @entity353 @entity229 @entity3446 @entity281 @entity2098 @entity1140 @entity1011
The first case of @entity8999 allograft @entity8 at the University of Maryland Renal Transplant Program was diagnosed in 1997. Since then more than 100 cases have been identified. The incidence of BKAN has increased from 1% for @entity1 transplanted in 1997 to 5.8% for @entity1 transplanted in 2001. BKAN is an important cause of premature kidney graft loss at the University of Maryland Transplant Program. One-third of the @entity1 diagnosed with BKAN since 1997 have already lost graft function, and a third of the remaining @entity1 have @entity1011 levels over 3 mg/dl. We could not determine that a specific immunosuppressive drug increased the incidence of BKAN. Older @entity1 had an increased risk of developing the disease. The histological diagnosis of BKAN was made at a mean time of 14.4 months after transplantation (range 1.2-53 months). BKAN occurred in 4.3% of all @entity1 biopsied during the period described. The diagnosis of BK allograft @entity8 was based on a combination of renal biopsy to demonstrate viral cytopathic chages, urine cytology and quantitative viral load in plasma. A threshold of >10,000 copies of @entity8999 per ml of plasma is proposed as an indication of BKAN. Following diagnosis of BKAN, @entity1 on a single immunosuppressve drug ( @entity1140 , CsA, @entity3446 or @entity2098 ) in addition to @entity229 had less graft loss and higher viral clearance in comparison to @entity1 on @entity229 and 2 immunosuppressant drugs ( @entity1140 , CsA or @entity3446 and @entity2098 ). There was no difference in the rate of acute allograft rejection among different @entity353 protocols. Three @entity1 who lost their grafts to BKAN were retransplanted. For these @entity1 there has not yet been evidence of recurrence of BKAN. After reduction of immunosuppression, the course of BKAN in most @entity1 followed one of 2 pathways: 1) Clearance of the @entity281 and disappearance of the viral cytopathic changes in biopsies and urine (20%); 2)Persistence of viral replication with continuous associated tubular damage (70%). Renal transplant @entity1 should be routinely screened with urine cytology. The presence of decoy cells in the urine is an indication for quantitative measurement of viral load in plasma. @entity1 with any evidence of BK viral reactivation should be followed closely. In @entity1 biopsied early due to persistence of @entity8999 -infected cells in urine, there is a higher rate of conversion from positive to negative urine cytology after reduction of immunosuppression.
