Parajuli Sandesh, Muth Brenda L, Turk Jennifer A, Astor Brad C, Mohammed Maha, Mandelbrot Didier A, Djamali Arjang
1 Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Transplantation. 2016 Mar;100(3):655-61. doi: 10.1097/TP.0000000000001061.
There is little information on the incidence, risk factors, and outcomes associated with CMV and BK infections in sensitized patients.
We examined 254 consecutive kidney transplant recipients with positive virtual crossmatch and negative flow crossmatch.
A total of 111 patients (43%) developed CMV disease or BK infection or nephropathy (BKVN). Specifically, 78 patients (30.7%) developed BK infection, 19 (7.5%) had BKVN, and 33 (12.9%) presented with CMV disease. Four patients (1.5%) developed both infections. Mean time from transplant to diagnosis for BK and CMV was 4.07 ± 3.10 and 8.35 ± 5.20 months, respectively. African American (HR, 2.64; 95% CI, 1.37-5.07; P = 0.003), thymoglobulin induction (HR, 2.18; 95% CI, 1.38-3.43; P = 0.0008), DSA greater than 500 MFI at transplant (HR, 1.64; 95% CI, 1.05-2.57; P = 0.03), history of diabetes (HR, 1.62; 95% CI, 1.01-2.60; P = 0.04), CMV D+/R- (HR, 2.30; 95% CI, 1.06-5.01; P = 0.03), and acute rejection (HR, 1.49; 95% CI, 0.99-2.24; P = 0.05) were associated with increase incident of BK/CMV, whereas rituximab (HR, 0.47; 95% CI, 0.24-0.91; P = 0.02), peak PRA greater than 80% (HR, 0.48; 95% CI, 0.27-0.84; P = 0.01), and living donor transplant (HR, 0.57; 95% CI, 0.36-0.87; P = 0.01) were associated with a lower likelihood of infection. Thymoglobulin induction (HR, 2.50; 95% CI, 1.02-6.13; P = 0.04), and peak PRA greater than 80% (HR, 0.45; 95% CI, 0.23-0.86; P = 0.02) remained significant predictors of infection after multivariate adjustment.
Although more than 40% of patients with a positive virtual crossmatch presented with BK infection/CMV disease, high PRA greater than 80% seemed to be protective.
关于致敏患者中巨细胞病毒（CMV）和BK病毒感染的发病率、危险因素及预后的信息较少。
我们对254例连续的虚拟交叉配型阳性且流式细胞术交叉配型阴性的肾移植受者进行了检查。
共有111例患者（43%）发生了CMV疾病、BK感染或肾病（BKVN）。具体而言，78例患者（30.7%）发生了BK感染，19例（7.5%）患有BKVN，33例（12.9%）出现了CMV疾病。4例患者（1.5%）发生了两种感染。BK和CMV从移植到诊断的平均时间分别为4.07±3.10个月和8.35±5.20个月。非裔美国人（风险比[HR]，2.64；95%置信区间[CI]，1.37 - 5.07；P = 0.003）、使用抗胸腺细胞球蛋白诱导治疗（HR，2.18；95% CI，1.38 - 3.43；P = 0.0008）、移植时供体特异性抗体（DSA）大于500平均荧光强度（MFI）（HR，1.64；95% CI，1.05 - 2.57；P = 0.03）、糖尿病史（HR，1.62；95% CI，1.01 - 2.60；P = 0.04）、CMV D+/R-（HR，2.30；95% CI，1.06 - 5.若需要添加其他任何解释或说明。
尽管超过40%的虚拟交叉配型阳性患者出现了BK感染/CMV疾病，但PRA大于80%似乎具有保护作用。 01；P = 0.03）以及急性排斥反应（HR，1.49；95% CI，0.99 - 2.24；P = 0.05）与BK/CMV感染发生率增加相关，而利妥昔单抗（HR，0.47；95% CI，0.24 - 0.91；P = 0.02）、峰值PRA大于80%（HR，0.48；95% CI，0.27 - 0.84；P = 0.01）以及活体供体移植（HR，0.57；95% CI，0.36 - 0.87；P = 0.01）与感染可能性较低相关。多因素调整后，使用抗胸腺细胞球蛋白诱导治疗（HR，2.50；95% CI，1.02 - 6.13；P = 0.04）以及峰值PRA大于80%（HR，0.45；95% CI，0.23 - 0.86；P = 0.02）仍是感染的显著预测因素。
