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肾移植患者感染细小病毒B19的危险因素及长期预后

Risk factors and long-term outcomes of parvovirus B19 infection in kidney transplant patients.

作者信息

Baek Chung Hee, Kim Hyosang, Yang Won Seok, Han Duck Jong, Park Su-Kil

机构信息

Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

Transpl Infect Dis. 2017 Oct;19(5). doi: 10.1111/tid.12754. Epub 2017 Sep 19.

Abstract

BACKGROUND

Parvovirus B19 is a small, non-enveloped, single-stranded DNA virus with a special affinity for the erythroid progenitor cells of the bone marrow. The first case of parvovirus B19 infection in a kidney transplant recipient (KTR) was reported in 1986. Data on the risk factors and specific clinical characteristics of parvovirus B19 infection remain insufficient.

METHODS

We screened 602 KTRs for parvovirus B19 infection using parvovirus B19 polymerase chain reaction (PCR) from January 1990 to April 2016, and the clinical characteristics of patients with positive results were compared to those of age- and gender-matched patients with negative PCR results.

RESULTS

A total of 39 KTRs tested positive for parvovirus B19, and they were compared to 78 age- and gender-matched patients among 563 KTRs who had negative PCR results. In all, 89.7% of positive cases were reported within the first year after kidney transplantation. In multivariate analyses, deceased-donor kidney transplantation (odds ratio [OR] 9.067, 95% confidence interval [CI] 1.668-49.275, P = .011), use of tacrolimus (OR 3.607, 95% CI 1.024-12.706, P = .046), PCR test within 1 year of kidney transplantation (OR 12.456, 95% CI 2.674-58.036, P = .001), and hemoglobin levels (OR 0.559, 95% CI 0.351-0.889, P = .014) showed significant correlations with parvovirus B19 infection. Graft survival did not differ between the two groups during the follow-up period of 111.68 ± 54.54 months (P = .685 by log-rank test).

CONCLUSION

The identification of factors related to positive parvovirus B19 PCR results may promote the early detection of parvovirus B19 infection. Further studies are needed to elucidate the characteristics of parvovirus B19 infection in kidney transplantation.

摘要

背景

细小病毒B19是一种小型、无包膜的单链DNA病毒,对骨髓中的红系祖细胞具有特殊亲和力。1986年报道了首例肾移植受者(KTR)感染细小病毒B19的病例。关于细小病毒B19感染的危险因素和具体临床特征的数据仍然不足。

方法

我们在1990年1月至2016年4月期间,使用细小病毒B19聚合酶链反应(PCR)对602例KTR进行了细小病毒B19感染筛查,并将检测结果为阳性的患者的临床特征与年龄和性别匹配的PCR检测结果为阴性的患者进行了比较。

结果

共有39例KTR的细小病毒B19检测呈阳性,并将他们与563例PCR检测结果为阴性的KTR中78例年龄和性别匹配的患者进行了比较。总体而言,89.7%的阳性病例是在肾移植后的第一年内报告的。在多因素分析中, deceased-donor肾移植(比值比[OR] 9.067,95%置信区间[CI] 1.668 - 49.275,P = 0.011)、使用他克莫司(OR 3.607,95% CI 1.024 - 12.706,P = 0.046)、肾移植后1年内进行PCR检测(OR 12.456,95% CI 2.674 - 58.036,P = 0.001)以及血红蛋白水平(OR 0.559,95% CI 0.351 - 0.889,P = 0.014)与细小病毒B19感染显著相关。在111.68 ± 54.54个月的随访期内,两组的移植物存活率没有差异(对数秩检验P = 0.685)。

结论

确定与细小病毒B19 PCR检测结果阳性相关的因素可能有助于早期发现细小病毒B19感染。需要进一步研究以阐明肾移植中细小病毒B19感染的特征。

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