Bagchi Soumita, Gopalakrishnan Vikraman, Srivastava Sandeep Kumar, Upadhayay Ashish, Singh Geetika, Bhowmik Dipankar, Mahajan Sandeep, Dinda Amit, Agarwal Sanjay Kumar
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Transpl Infect Dis. 2017 Dec;19(6). doi: 10.1111/tid.12770. Epub 2017 Oct 25.
There is a paucity of data available about BK polyomavirus (BKPyV) infection after renal transplantation (RTX) in resource-limited countries with a predominantly living-donor, ABO-compatible RTX program. We aimed to assess BKPyV infection in such patients in a public hospital in India.
We prospectively evaluated plasma BKPyV replication in 62 patients at 1, 3, 6, 9, and 12 months after RTX. Sustained significant BK viremia (SSBKV) was defined as significant viremia (≥10 000 copies/mL) detected ≥2 times, and BKPyV-associated nephropathy (BKVAN) as histologic changes of BKVAN with BK viremia with/without graft dysfunction.
All patients underwent RTX without requiring desensitization. Incidence of BK viremia was: 17.7%, 41.9%, 16.1%, 25.8%, and 17.7% at 1, 3, 6, 9, and 12 months, respectively. Of 62 patients, 64.5% had BKPyV viremia during the study, 32.2% had significant viremia, all except one detected in the first 6 months. Nine (14.5%) patients had SSBKV. There was no biopsy-proven BKVAN. At the end of 1 year, mean serum creatinine was higher and graft dysfunction was significantly more common in patients with SSBKV compared to those without SSBKV.
Transient BK viremia is common in low/intermediate immunologic risk RTX recipients in India, with a peak occurring at 3-6 months. Most clear their viremia by 12 months. Graft dysfunction seems to be more frequent in patients with SSBKV, although BKVAN is uncommon on biopsy in these patients.
在以活体供肾、ABO血型相容肾移植项目为主的资源有限国家，关于肾移植（RTX）后BK多瘤病毒（BKPyV）感染的数据匮乏。我们旨在评估印度一家公立医院此类患者的BKPyV感染情况。
我们前瞻性评估了62例患者在RTX后1、3、6、9和12个月时血浆中BKPyV的复制情况。持续性显著BK病毒血症（SSBKV）定义为检测到≥2次显著病毒血症（≥10000拷贝/毫升），BKPyV相关肾病（BKVAN）定义为伴有BK病毒血症且有/无移植肾功能障碍的BKVAN组织学改变。
所有患者均接受了RTX，无需脱敏。BK病毒血症的发生率分别为：1个月时17.7%，3个月时41.9%，6个月时16.1%，9个月时25.8%，12个月时17.7%。在62例患者中，64.5%在研究期间出现BKPyV病毒血症，32.2%出现显著病毒血症，除1例外在前6个月检测到。9例（14.5%）患者出现SSBKV。没有经活检证实的BKVAN。1年末，与无SSBKV的患者相比，有SSBKV的患者平均血清肌酐更高，移植肾功能障碍显著更常见。
在印度低/中度免疫风险的RTX受者中，短暂性BK病毒血症很常见，高峰出现在3至6个月。大多数患者在12个月时清除病毒血症。尽管这些患者经活检BKVAN不常见，但SSBKV患者的移植肾功能障碍似乎更频繁。
