Ali Abdalla M, Gibson Ian W, Birk Patricia, Blydt-Hansen Tom D
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
Pediatr Transplant. 2011 Dec;15(8):827-34. doi: 10.1111/j.1399-3046.2011.01583.x.
This study investigated the age-related prevalence of a prior polyoma BKV infection at the time of transplantation and association with subsequent development of BKV viremia. We measured BKV-specific antibody titers in stored serum samples obtained before transplantation in 94 pediatric kidney transplant recipients (in a single-center, retrospective analysis) and 40 matched donors from 1986 to 2007. Titers were categorized as LOW or HIGH serostatus at titers of ≤ 1:2560 and ≥ 1:10 240, respectively. Of these, 36 recipients transplanted since 2002 were prospectively screened for BKV viremia. Seventeen percent of recipients aged 0-6 yr had HIGH BKV serostatus compared with 73% of older recipients (p < 0.002). The prevalence of HIGH donor BKV serostatus was 73%. Five prospectively screened patients (14%) developed early BKV viremia, and an additional 4 (11%) had late onset of BKV viremia. There were three cases (8%) of BKVAN. LOW BKV serostatus was significantly associated with early BKV viremia (p = 0.02). Donor HIGH to recipient LOW (HIGH/LOW) had the highest risk of BKV viremia (4/7; 57%), compared with LOW/LOW (0/3; 0%) and recipient HIGH (1/26; 4%) (p = 0.004). BKV IgG titers are low in young pediatric kidney transplant recipients, and LOW BKV serostatus is associated with an increased risk of early BKV infection post-transplant, particularly in the context of donor with HIGH BKV serostatus.
本研究调查了移植时既往多瘤病毒BK（BKV）感染的年龄相关患病率及其与随后BKV病毒血症发生的关联。我们在1986年至2007年期间对94名小儿肾移植受者（单中心回顾性分析）及40名匹配供者移植前采集的储存血清样本中检测了BKV特异性抗体滴度。滴度分别在≤1:2560和≥1:10240时被分类为低或高血清状态。其中，对2002年以来接受移植的36名受者进行了BKV病毒血症的前瞻性筛查。0至6岁受者中17%具有高BKV血清状态，而年龄较大的受者中这一比例为73%（p<0.002）。供者高BKV血清状态的患病率为73%。5名前瞻性筛查患者（14%）发生了早期BKV病毒血症，另外4名（11%）出现了迟发性BKV病毒血症。有3例（8%）发生了BKV相关性肾病（BKVAN）。低BKV血清状态与早期BKV病毒血症显著相关（p=0.02）。供者高/受者低（HIGH/LOW）发生BKV病毒血症的风险最高（4/7；57%），相比之下，低/低（0/3；0%）和受者高（1/26；4%）（p=0.004）。小儿肾移植受者中BKV IgG滴度较低，低BKV血清状态与移植后早期BKV感染风险增加相关，尤其是在供者具有高BKV血清状态的情况下。
