Schwarz Anke, Linnenweber-Held Silvia, Heim Albert, Framke Theodor, Haller Hermann, Schmitt Corinna
1 Department of Nephrology Hannover Medical School, Hannover, Germany. 2 Institute of Virology Hannover Medical School, Hannover, Germany. 3 Institute for Biostatistics, Hannover Medical School, Hannover, Germany.
Transplantation. 2016 Apr;100(4):844-53. doi: 10.1097/TP.0000000000001066.
BK virus (BKV) nephropathy remains the main cause of renal graft loss after living-donor renal transplantation. The aim of the study was to investigate the source and factors influencing the course of BKV infection.
We investigated 214 living donor-recipient pairs. Urine and blood of donors and recipients were tested by qPCR for the presence of BKV DNA before and after transplantation; genotyping of BKV subtypes was performed.
Eighty-five recipients (40%) had posttransplant BK viruria including 61 with additional viremia and 22 with nephropathy. Pretransplant urinary BKV shedding of donor or recipient was a significant risk factor for posttransplant viruria and viremia (OR, 4.52; CI, 2.33-8.77; P < 0.0001) and nephropathy (OR, 3.03; CI, 1.16-7.9; P = 0.02). In the BKV nephropathy group, urine and blood became BKV positive earlier than in the group with viruria and viremia. Renal function was worse in BKV-nephropathy compared with BKV-negative patients beginning at transplantation. Comparing BKV subtypes of donor and recipient before with the subtype of the infected recipient after transplantation, donor-derived transmission was identified in 24 of 28 corresponding pairs. BKV subtype IV had a higher prevalence in recipients with BKV nephropathy than in those with viruria and viremia (P = 0.045).
Pretransplant urinary BKV shedding of donor and recipient is a risk for posttransplant infection. Donor-derived BKV transmission is an important mode of infection. BKV subtype IV may be one of the viral determinants. Early BKV positivity of urine and blood indicates later BKV nephropathy. Decreased renal function may favor BKV infection.
BK病毒（BKV）肾病仍然是活体供肾肾移植后肾移植丢失的主要原因。本研究的目的是调查BKV感染的来源及影响其病程的因素。
我们对214对活体供受者进行了调查。在移植前后，通过qPCR检测供者和受者的尿液和血液中是否存在BKV DNA；对BKV亚型进行基因分型。
85名受者（40%）移植后出现BK病毒尿，其中61名伴有病毒血症，22名患有肾病。供者或受者移植前尿液中BKV脱落是移植后病毒尿和病毒血症（比值比[OR]，4.52；可信区间[CI]，2.33 - 8.77；P < 0.0001）以及肾病（OR，3.03；CI，1.16 - 7.9；P = 0.02）的显著危险因素。在BKV肾病组中，尿液和血液BKV阳性出现的时间早于病毒尿和病毒血症组。从移植开始，BKV肾病患者的肾功能比BKV阴性患者更差。比较移植前供者和受者的BKV亚型与移植后感染受者的亚型，在28对相应配对中，有24对确定为供者来源的传播。BKV亚型IV在患有BKV肾病的受者中的患病率高于患有病毒尿和病毒血症的受者（P = 0.045）。
供者和受者移植前尿液中BKV脱落是移植后感染的危险因素。供者来源的BKV传播是一种重要的感染方式。BKV亚型IV可能是病毒决定因素之一。尿液和血液中BKV早期阳性提示后期发生BKV肾病。肾功能下降可能有利于BKV感染。
