Serum and urine nucleic acid screening tests for BK polyomavirus-associated nephropathy in kidney and kidney-pancreas transplant recipients.
Maung Myint, T., et al.Cochrane Database of Systematic Reviews 2024; 11: CD014839.
Aims
This review aimed to examine the diagnostic accuracy of quantitative nucleic acid testing (QNAT) in patients with BK polyomavirus-associated nephropathy (BKPyVAN).
Interventions
Databases including MEDLINE (OvidSP), EMBASE (OvidSP), and BIOSIS, and the Cochrane Register of diagnostic test accuracy studies were searched for literature. Study selection and data extraction were performed independently by two reviewers. The methodological quality was assessed using the Quality Assessment of Diagnostic-Accuracy Studies (QUADAS-2) tool.
Participants
31 studies including a total of 6559 participants were included in the review.
Outcomes
Sensitivity and specificity.
Follow-up
N/A
CET Conclusions
This is Cochrane Review of screening tests for BKV nepropathy following kidney and combined kidney-pancreas transplantation. Blood/plasma/serum BKV QNAT and urine BKV QNAT were compared to the reference standard(histopathology). As expected the review searched widely in multiple databases, abstracts were selected in duplicate, data extraction was conducted in duplicate, and quality assessment was done in duplicate. By nature the included studies are cross-sectional or cohort studies, with a total patient population over 6500, across 31 studies. There is an in depth analysis of sensitivity and specificity of the test, as well as subgroup analysis to exclude studies at higher risk of bias. Using a commonly reported threshold for the viral load of 10,000 copies/mL in meta-analysis, the summary estimates sensitivity of 0.85, and specificity was 0.95. In regular screening a threshold of 2000 copies/mL had a sensitivity of 0.89 and specificity of 0.88. The authors felt that there was insufficient evidence to use BKV QNAT as the primary screening tool for BKV nephropathy after renal transplantation.
Trial registration
N/A