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Journal of Transplantation
Volume 2012 (2012), Article ID 761283, 7 pages
http://dx.doi.org/10.1155/2012/761283
Clinical Study

Progression from Sustained BK Viruria to Sustained BK Viremia with Immunosuppression Reduction Is Not Associated with Changes in the Noncoding Control Region of the BK Virus Genome

1Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
2Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
3Department of Pathology, Washington University School of Medicine, St. Louis, MO 63110, USA
4Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA

Received 31 January 2012; Accepted 5 April 2012

Academic Editor: Andreas Zuckermann

Copyright © 2012 Imran A. Memon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Changes in the BK virus archetypal noncoding control region (NCCR) have been associated with BK-virus-associated nephropathy (BKVAN). Whether sustained viremia, a surrogate for BKVAN, is associated with significant changes in the BK-NCCR is unknown. We performed PCR amplification and sequencing of (1) stored urine and (2) plasma samples from the time of peak viremia from 11 patients with sustained viremia who participated in a 200-patient clinical trial. The antimetabolite was withdrawn for BK viremia and reduction of the calcineurin inhibitor for sustained BK viremia. DNA sequencing from the 11 patients with sustained viremia revealed 8 insertions, 16 transversions, 3 deletions, and 17 transitions. None were deemed significant. No patient developed clinically evident BKVAN. Our data support, at a genomic level, the effectiveness of reduction of immunosuppression for prevention of progression from viremia to BKVAN.