Amsterdam UMC, University of Amsterdam, Department of Pathology, Amsterdam Infection & Immunity Institute (AI&II), Amsterdam Cardiovascular Sciences (ACS), Meibergdreef 9, Amsterdam, The Netherlands.
Department of Nephrology, Geneva University Hospitals, Geneva, Switzerland.
Transplantation. 2019 Dec;103(12):2692-2700. doi: 10.1097/TP.0000000000002712.
With current immunosuppressive regimens, BK polyomavirus-associated nephropathy (BKPyVAN) is still a matter of concern. Stratification of patients at risk for allograft loss is of uttermost importance to guide treatment choice and assess prognosis. In 2018, the Banff working group proposed a classification scheme for the prognosis of BKPyVAN, but external application on independent cohorts is yet to be performed. We investigated how the 2018 Banff classification would perform in a multicenter cohort comprising 50 cases of biopsy-proven BKPyVAN compared to previously published classification systems.
We analyzed consecutive BKPyVAN cases from two Dutch university hospitals between 2002 and 2013, retrieved clinical data, and scored all biopsies according to the Banff 2018 classification, and as a comparison, 4 previously proposed BKPyVAN classification systems. We used estimated glomerular filtration rate trajectories and death-censored graft survival as primary endpoints.
The 2018 Banff classification did not associate with estimated glomerular filtration rate decline or graft failure and performed only slightly better than the 4 previously proposed classifiers. Anti-human leukocyte antigen donor-specific antibodies (DSAs), especially in combination with ongoing biopsy-proven BKPyVAN on follow-up, did correlate with graft function and survival. Patients who were DSA+/BKPyVAN+ on follow-up had more inflammation at the baseline biopsy, which by itself was not associated with graft outcomes.
Neither the 2018 Banff BKPyVAN classification nor previously published stratification systems could be applied to our multicenter patient cohort. Our data suggest that there might be a prognostic value for follow-up biopsies and DSA measurements to improve risk stratification after BKPyVAN, although prospective multicenter efforts with protocol measurements are needed to confirm this.
尽管目前采用了免疫抑制疗法，但 BK 多瘤病毒相关性肾病（BKPyVAN）仍然是一个令人关注的问题。对发生移植物丢失风险的患者进行分层对于指导治疗选择和评估预后至关重要。2018 年，Banff 工作组提出了一种 BKPyVAN 预后分类方案，但尚未在独立队列中进行外部应用。我们调查了 2018 年 Banff 分类方案在包含 50 例经活检证实的 BKPyVAN 患者的多中心队列中的表现，并与以前发表的分类系统进行了比较。
我们分析了 2002 年至 2013 年间来自荷兰两所大学医院的连续 BKPyVAN 病例，检索了临床数据，并根据 2018 年 Banff 分类以及作为比较的 4 种以前提出的 BKPyVAN 分类系统对所有活检进行评分。我们使用估算的肾小球滤过率轨迹和死亡相关的移植物存活率作为主要终点。
2018 年 Banff 分类与估算的肾小球滤过率下降或移植物失败无关，其表现仅略优于 4 种以前提出的分类器。抗人类白细胞抗原供体特异性抗体（DSA），尤其是与后续活检中持续存在的 BKPyVAN 相结合，与移植物功能和存活相关。在后续研究中为 DSA+/BKPyVAN+的患者在基线活检时有更多的炎症，而炎症本身与移植物结局无关。
无论是 2018 年 Banff BKPyVAN 分类还是以前发表的分层系统都无法应用于我们的多中心患者队列。我们的数据表明，在 BKPyVAN 后进行随访活检和 DSA 测量可能具有预后价值，以改善风险分层，尽管需要进行前瞻性多中心研究来证实这一点。
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