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Urinary VP1 Flow Cytometry as a Complementary Approach for BK Polyomavirus Monitoring: A Proof-Of-Concept Study.

Haris Omic1,1, David Vecsei1, Michael Eder1

  • 1Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.

Transplant International : Official Journal of the European Society for Organ Transplantation
|April 24, 2026
PubMed
Summary
This summary is machine-generated.

A novel urine test using VP1-positive cells shows promise in diagnosing polyomavirus nephropathy (BKPyVAN) after kidney transplants, potentially offering a less invasive alternative to biopsies. This method may also track treatment response more effectively than current plasma tests.

Keywords:
BK polyomavirus–associated nephropathykidney transplantationliquid biopsyurinary VP1 flow cytometryviral biomarkers

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Area of Science:

  • Nephrology
  • Virology
  • Transplantation Immunology

Background:

  • Polyomavirus nephropathy (BKPyVAN) significantly impacts kidney allograft survival post-transplantation.
  • Current diagnostic methods like plasma BKPyV-PCR may not accurately reflect active kidney tissue injury.
  • There is a need for non-invasive markers to assess BKPyVAN and monitor treatment efficacy.

Purpose of the Study:

  • To evaluate urinary VP1-positive epithelial cells as a novel, non-invasive biomarker for biopsy-proven BKPyVAN.
  • To compare the diagnostic performance of urinary VP1-positivity against plasma BKPyV-PCR.
  • To assess the utility of urinary VP1-positivity in monitoring treatment response longitudinally.

Main Methods:

  • A prospective observational study involving 30 kidney transplant recipients with BKPyV reactivation.
  • Analysis of urine samples via flow cytometry to quantify VP1-positive epithelial cells.
  • Comparison of urinary VP1-positivity between patients with biopsy-proven BKPyVAN and controls, and longitudinal tracking during follow-up.

Main Results:

  • Urinary VP1-positivity was significantly higher in biopsy-proven BKPyVAN patients (33%) compared to non-BKPyVAN patients (5%).
  • The assay demonstrated high diagnostic accuracy (AUC=0.98, sensitivity=91%, specificity=89%) for biopsy-proven BKPyVAN.
  • Longitudinal analysis showed a decline in VP1-burden to undetectable levels, preceding the plateau of BKPyV-DNAemia.

Conclusions:

  • Urinary VP1-positive cells represent a promising non-invasive marker for diagnosing BKPyVAN in kidney transplant recipients.
  • Combining urinary VP1-positivity with plasma BKPyV-PCR may improve diagnostic accuracy and differentiate active BKPyVAN.
  • Longitudinal VP1 tracking could offer earlier indication of viral infection resolution than plasma DNA levels, warranting further validation.