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• W2330587726 abstract "We welcome the additional data provided by Nickeleit et al. (1) detailing their unit’s experience using decoy cell analysis as the initial screening method to detect reactivation of BK virus after renal transplantation. We are reassured that their data mirrors our own experience, demonstrating a relatively short median time until the detection of decoy cells after transplantation, an excellent negative predictive value, and the delivery of significant cost savings through the use of this strategy (2). Combining the results from these two studies, we believe there are some points that deserve further emphasis. Because viruria predates viremia, the presence of urinary decoy cells provides an earlier marker than plasma nucleic acid detection that a patient may be at risk for immunosuppression-related complications. Decoy cell analysis is not being promoted as an alternative to nucleic acid testing but rather a complementary strategy to identify patients at higher risk who are most likely to benefit from viral nucleic acid testing. Furthermore, we agree that the ability to use urine samples for Haufen testing and decoy cell assessment is an appealing prospect (3), because although biopsy is considered the gold standard for diagnosing polyomavirus nephropathy (PVN), the patchy nature of viral replication can result in false-negative results. This is of particular concern where the associated lymphocytic infiltrate (reflecting the host antiviral response) may be misconstrued as representing acute rejection, leading to inappropriate escalation of immunosuppression. Indeed, even in the presence of positive SV40 staining, there is often a clinical conundrum with biopsies reported as demonstrating PVN also meeting Banff criteria for acute rejection. In a previous study, we demonstrated that analysis of BK virus–specific T-cell responses can help identify patients capable of clearing the virus (4); therefore, there is the potential for a combination of relatively noninvasive tests: decoy screen screening, urinary Haufen testing, plasma quantitative polymerase chain reaction, and T-cell enzyme-linked immunosorbent spot analyses, to define patients at risk of PVN, identify those who have developed PVN, and establish which patients may require a reduction in their immunosuppression to enable the development of functional T-cell responses to enable viral clearance. Aron Chakera 1 Oliver-James Dyar2 Elizabeth Hughes3 Sophia Bennett2 David Hughes3 Ian S.D. Roberts4 1 School of Medicine and Pharmacology University of Western Australia Perth, WA, Australia 2 Nuffield Department of Clinical Medicine University of Oxford Oxford, UK 3 Oxford Transplant Unit Churchill Hospital Oxford, UK 4 Department of Cellular Pathology John Radcliffe Hospital Oxford, UK" @default.
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• W2330587726 date "2012-10-15" @default.
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• W2330587726 title "Reply to Correspondence Regarding “Detection of Polyomavirus BK Reactivation After Renal Transplantation Using an Intensive Decoy Cell Surveillance Program is Cost Effective”" @default.
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• W2330587726 doi "https://doi.org/10.1097/tp.0b013e31826784f5" @default.
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