The Role of HLA and KIR Immunogenetics in BK Virus Infection after Kidney Transplantation

BK virus (BKV) is a polyomavirus with high seroprevalence in the general population with an unremarkable clinical presentation in healthy people, but a potential for causing serious complications in immunosuppressed transplanted patients. Reactivation or primary infection in kidney allograft recipients may lead to allograft dysfunction and subsequent loss. Currently, there is no widely accepted specific treatment for BKV infection and reduction of immunosuppressive therapy is the mainstay therapy. Given this and the sequential appearance of viruria-viremia-nephropathy, screening and early detection are of utmost importance. There are numerous risk factors associated with BKV infection including genetic factors, among them human leukocyte antigens (HLA) and killer cell immunoglobulin-like receptors (KIR) alleles have been shown to be the strongest so far. Identification of patients at risk for BKV infection would be useful in prevention or early action to reduce morbidity and progression to frank nephropathy. Assessment of risk involving HLA ligands and KIR genotyping of recipients in the pre-transplant or early post-transplant period might be useful in clinical practice. This review summarizes current knowledge of the association between HLA, KIR and BKV infection and potential future directions of research, which might lead to optimal utilization of these genetic markers.

Impact of Providing Data on Family Medicine Practice Management Education

Background and Objectives: Residents need to learn about practice management, including how to improve the quality of their patient care utilizing practice data. However, little is known about the effectiveness of providing practice data to residents. This study examined the effectiveness of utilizing resident practice management reports. Methods: We provided residents quarterly practice management reports with individual resident data on coding compliance (determined by manual chart review by a certified coder), clinical productivity (number of clinic sessions, visits per session, relative value units [RVUs] per visit, and RVUs per session), and patient quality outcomes (rates of diabetes mellitus control, diabetic nephropathy screening/management, hypertension control, influenza immunization, pneumococcal immunization, and colorectal cancer screening). We compared all data to national metrics. Quality outcome data was also provided by clinical team and with comparison to nonresidency departmental clinics. We surveyed residents before and after receiving these practice management reports to determine how they felt it prepared them for future practice (on a 9-point Likert scale). Results: There was significant improvement in the ability to implement clinic-based processes to improve patient care (6.5 vs 5.6; P=.04) and learning about clinical productivity/financial aspects of practicing family medicine (6.3 vs 5.4; P=.03). Other areas had trends of improvement, although not statistically significant. Conclusions: Providing residents with their clinic practice data, with reference to team practice data and national benchmarks further helps them learn and apply practice management, when superimposed on an existing infrastructure to teach practice management.