BK病毒监测对肾移植受者预后的临床影响。
Clinical impact of BK virus surveillance on outcomes in kidney transplant recipients.
作者信息
Yoon S-H, Cho J-H, Jung H-Y, Choi J-Y, Park S-H, Kim Y-L, Kim H-K, Huh S, Kim C-D
机构信息
Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea.
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
出版信息
Transplant Proc. 2015 Apr;47(3):660-5. doi: 10.1016/j.transproceed.2014.11.051.
BACKGROUND
The objective of this study was to investigate the clinical impact of BK virus surveillance on graft injury in kidney transplantation.
METHODS
BK viremia in kidney transplant recipients was evaluated by use of plasma quantitative polymerase chain reaction. The prevalence of BK viremia and BK virus-associated nephropathy (BKVAN) and the clinical impact of BK viremia on graft outcomes were assessed.
RESULTS
This study took place between January 2008 and June 2013. A total of 213 kidney transplant recipients were included. The prevalence of BK viremia and high BK viremia (≥1 × 10(4) copies/mL) was 66.7% (142/213) and 17.4% (37/213), respectively. A diagnosis of BKVAN was confirmed by means of allograft biopsy in 9 patients (4.2%). The estimated glomerular filtration rate after transplantation was similar in both the low BK viremia (<1 × 10(4) copies/mL) and non-BK viremia groups but was significantly lower in the high BK viremia group after 18 months. In receiver operating characteristic curve analysis, the area under the curve value of plasma polymerase chain reaction was 0.980. We found that a viral load >92,850 copies/mL was able to predict BKVAN with 89% sensitivity and 94.6% specificity. The risk factors for viral loads ≥1 × 10(4) copies/mL were cytomegalovirus infection, steroid pulse therapy, and acute rejection.
CONCLUSIONS
High BK viremia was associated with poor graft function after kidney transplantation. The serial monitoring of BK viremia in kidney transplant recipients was helpful in predicting BKVAN and might prevent further progression.
背景
本研究的目的是调查BK病毒监测对肾移植中移植物损伤的临床影响。
方法
采用血浆定量聚合酶链反应评估肾移植受者的BK病毒血症。评估BK病毒血症和BK病毒相关性肾病（BKVAN）的患病率以及BK病毒血症对移植物结局的临床影响。
结果
本研究于2008年1月至2013年6月进行。共纳入213例肾移植受者。BK病毒血症和高BK病毒血症（≥1×10⁴拷贝/mL）的患病率分别为66.7%（142/213）和17.4%（37/213）。通过移植肾活检确诊9例（4.2%）BKVAN。移植后18个月时，低BK病毒血症（<1×10⁴拷贝/mL）组和无BK病毒血症组的估计肾小球滤过率相似，但高BK病毒血症组显著降低。在受试者工作特征曲线分析中，血浆聚合酶链反应的曲线下面积值为0.980。我们发现病毒载量>92,850拷贝/mL能够以89%的敏感性和94.6%的特异性预测BKVAN。病毒载量≥1×10⁴拷贝/mL的危险因素为巨细胞病毒感染、类固醇冲击治疗和急性排斥反应。
结论
高BK病毒血症与肾移植后移植物功能不良相关。对肾移植受者进行BK病毒血症的连续监测有助于预测BKVAN，并可能防止病情进一步进展。
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