O‐8FALSE NEGATIVE BRONCHIAL CYTOLOGY

Introduction: BK virus nephropathy is an emerging cause of renal transplant failure accounting for allograft loss in 45–50% of recipients between 2–60 months post‐transplantation. The Renal Transplant Unit in Royal Free Hospital has devised a local surveillance programme for screening renal transplant patients at weekly intervals by urinary cytology (UC) and electron microscopy (EM), and confirmation of positive results by plasma PCR and allograft biopsy. Objective: (i) To monitor the implementation of local guidelines; (ii) To compare UC with EM and (iii) To identify areas for improvement. Methods: Decoy cell and EM positive cases were retrieved from the WinPath database for new renal transplant recipients (n = 55) during 1^st November 2004 to 31^st October 2005 in Royal Free Hospital. Plasma PCR was retrieved for positive cases. Results: Up to eight samples were sent for UC at random intervals from 47 patients, and up to 7 were sent for EM from 42 patients. Eleven were UC‐positive and one was EM‐positive. PCR was not requested in UC‐positive cases and 3 out of 10 were positive retrospectively. The EM‐positive case was PCR‐positive but UC‐negative. Discussion: Urine Cytology is more appropriate and cost effective for screening than Electron Microscopy. During the period covered by this audit, samples were sent in an inconsistent fashion after allograft dysfunction rather than for screening. A screening protocol has been agreed and a re‐audit is planned.