Verghese P S, Schmeling D O, Filtz E A, Matas A J, Balfour H H
Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN, USA.
Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA.
Pediatr Transplant. 2017 Aug;21(5). doi: 10.1111/petr.12942. Epub 2017 May 29.
We previously demonstrated that detectable BKV replication in donor urine pretransplant was significantly associated with post-transplant recipient BKV viremia. In this 4-year prospective study, we assessed whether recipient BKV replication pretransplant was associated with post-transplant viremia/BKV nephropathy. We studied 220 primary adult and pediatric organ transplant recipients for 490 person-years and 2100 clinical visits. BKV viruria was detectable in 28 (16%), 26 adults and two children; and viremia in none pretransplant. Post-transplant viruria occurred in all recipients with pretransplant BKV viruria, significantly more than in recipients without pretransplant viruria on univariate (P<.005) and multivariate analysis including type of organ transplanted and immunosuppression type (P .008). Time to post-transplant viruria was significantly shorter in recipients with pretransplant viruria (P .01). By univariate and multivariate analysis, BKV viruria in recipients pretransplant did not impact post-transplant BKV viremia (P=.97 and .97, respectively) even when stratified by type of organ transplant (kidney P=.6; liver P=.5). The peak serum and urine BKV PCR post-transplant were not significantly different in patients with pretransplant BKV viruria and no one developed BK nephropathy. In conclusion, recipient BKV viruria prior to transplant predicts post-transplant viruria but not viremia or BKV nephropathy.
我们之前证明，移植前供体尿液中可检测到的BK病毒复制与移植后受者的BK病毒血症显著相关。在这项为期4年的前瞻性研究中，我们评估了移植前受者的BK病毒复制是否与移植后病毒血症/ BK病毒肾病相关。我们对220例成人和儿童原发性器官移植受者进行了490人年的研究及2100次临床访视。移植前，28例（16%）可检测到BK病毒尿，其中26例成人，2例儿童；无一例检测到病毒血症。所有移植前有BK病毒尿的受者移植后均出现病毒尿，在单因素分析（P<0.005）以及包括移植器官类型和免疫抑制类型的多因素分析中（P = 0.008），显著多于移植前无病毒尿的受者。移植前有病毒尿的受者移植后出现病毒尿的时间显著缩短（P = 0.01）。通过单因素和多因素分析，移植前受者的BK病毒尿即使按移植器官类型分层（肾脏P = 0.6；肝脏P = 0.5），也不影响移植后BK病毒血症（分别为P = 0.97和0.97）。移植前有BK病毒尿的患者移植后血清和尿液BK病毒PCR峰值无显著差异，且无一例发生BK肾病。总之，移植前受者的BK病毒尿可预测移植后病毒尿，但不能预测病毒血症或BK病毒肾病。
