Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Clin Transplant. 2018 Mar;32(3):e13194. doi: 10.1111/ctr.13194. Epub 2018 Feb 11.
The risk of de novo donor-specific antibody (dnDSA) development following BK viremia (BKV) or nephropathy (BKN) after kidney transplant remains unclear. We aimed to evaluate the relationships among dnDSA, BKV (BK blood PCR > 15 000 copies), BKN, antibody-mediated rejection (AMR), and allograft loss.
We performed a retrospective cohort study of 904 solitary kidney transplant recipients transplanted between 10/2007 and 5/2014. Cox proportional hazards regression with time-dependent covariates were used to assess the relationships among BKN, isolated BKV, dnDSA, and the subsequent risk of AMR and allograft loss.
In multivariate analysis, we observed that BKN, but not BKV was a risk factor for dnDSA (HR, 3.18, P = .008). Of the patients with BK nephropathy, 14.0% (6/43) developed dnDSA, which occurred within 14 months of BK diagnosis. DnDSA in this setting remains a risk factor for subsequent AMR (HR 4.75, P = .0001) and allograft loss (HR 2.63, P = .018).
BKN is an independent risk factor for development of dnDSA. Improved understanding of the characteristics of patients with BKN who are at highest risk for development of dnDSA would be valuable to customize immunosuppression reduction in this population.
肾移植后发生 BK 病毒血症（BKV）或肾病（BKN）后产生新生供者特异性抗体（dnDSA）的风险尚不清楚。本研究旨在评估 dnDSA 与 BKV（BK 血 PCR＞15000 拷贝）、BKN、抗体介导的排斥反应（AMR）和移植物丢失之间的关系。
我们进行了一项回顾性队列研究，纳入了 2007 年 10 月至 2014 年 5 月期间接受单肾移植的 904 例患者。采用时依协变量 Cox 比例风险回归来评估 BKN、孤立性 BKV、dnDSA 与 AMR 和移植物丢失的后续风险之间的关系。
多变量分析显示，BKN 而非 BKV 是 dnDSA 的危险因素（HR，3.18，P=0.008）。在发生 BKV 肾病的患者中，14.0%（6/43）发生了 dnDSA，其发生于 BK 诊断后的 14 个月内。在这种情况下，dnDSA 仍然是随后发生 AMR（HR 4.75，P=0.0001）和移植物丢失（HR 2.63，P=0.018）的危险因素。
BKN 是 dnDSA 发展的独立危险因素。深入了解发生 dnDSA 风险最高的 BKN 患者的特征，将有助于为该人群定制免疫抑制药物的减量方案。
