Ji Jiawei, Feng Sujuan, Jiang Yihang, Wang Wei, Zhang Xiaodong
From the Urology Institute of Capital Medical University, Department of Urology, Capital Medical University Beijing Chaoyang Hospital, Beijing, China.
Exp Clin Transplant. 2019 Dec;17(6):727-731. doi: 10.6002/ect.2018.0262. Epub 2019 Apr 17.
BK virus is a polyomavirus that can cause nephropathy and graft loss after kidney transplant. The aim of our study was to screen the BK viremia prevalence, to understand the value of the inter-vention for BK virus nephropathy, and to determine the risk factors associated with BK viremia after kidney transplant in our center.
Our retrospective cross-sectional study included 91 adult kidney transplant recipients who were seen between 2015 and 2017 and who had follow-up from 1 month to over 2 years. BK viremia was evaluated by use of plasma quantitative polymerase chain reaction. The prevalence of BK viremia and the clinical treatments and outcomes of BK virus nephropathy were assessed.
The prevalence of BK viremia was 5.5% (5/91 patients). BK virus nephropathy was confirmed by allograft biopsy in 4.4% (4/91 patients) of all patients. Delayed graft function was found to be an independent risk factor for BK viremia (P < .001). Patients with BK viremia had significantly higher serum creatinine levels (P = .04). Patients who were diagnosed with BK viremia at 1 to 5 years after kidney transplant had higher serum creatinine (P = .02) and uric acid levels (P = .02). After reduction or discontinuation of calcineurin inhibitor, BK virus was cleared in all patients with BK virus nephropathy, with higher level of serum creatinine but no graft loss.
Delayed graft function was considered as a risk factor for viremia. Early detection of BK viremia replication is important. The strategy of reduction of immunosuppression was effective for BK virus nephropathy and graft function improvement.
BK病毒是一种多瘤病毒，可导致肾移植后肾病和移植肾丢失。我们研究的目的是筛查BK病毒血症的患病率，了解BK病毒性肾病干预措施的价值，并确定本中心肾移植后与BK病毒血症相关的危险因素。
我们的回顾性横断面研究纳入了91例成年肾移植受者，这些患者在2015年至2017年期间就诊，随访时间为1个月至2年以上。采用血浆定量聚合酶链反应评估BK病毒血症。评估BK病毒血症的患病率以及BK病毒性肾病的临床治疗和结局。
BK病毒血症的患病率为5.5%（91例患者中的5例）。在所有患者中，4.4%（91例患者中的4例）经移植肾活检确诊为BK病毒性肾病。移植肾功能延迟被发现是BK病毒血症的独立危险因素（P < .001）。BK病毒血症患者的血清肌酐水平显著更高（P = .04）。肾移植后1至5年被诊断为BK病毒血症的患者血清肌酐（P = .02）和尿酸水平更高（P = .02）。在减少或停用钙调神经磷酸酶抑制剂后，所有BK病毒性肾病患者的BK病毒均被清除，血清肌酐水平较高但无移植肾丢失。
移植肾功能延迟被认为是病毒血症的危险因素。早期检测BK病毒血症复制很重要。减少免疫抑制的策略对BK病毒性肾病和移植肾功能改善有效。
