Chan Brandon Dow, Wong Gabriella, Jiang Qing, Lee Magnolia Muk-Lan, Wong Wing-Yan, Chen Feifei, Wong Wing-Tak, Zhu Lixing, Wong Francis Kim-Ming, Tai William Chi-Shing
Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R, China.
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Microb Pathog. 2020 Feb 1;142:104036. doi: 10.1016/j.micpath.2020.104036.
In the immunocompromised conditions following renal transplantation, BK virus can reactivate and cause BK virus associated nephropathy (BKVN). Increased BK viral loads and extended duration of infection have been linked to development of BKVN. The aim of this study was to observe the incidence of BKV infection and BKVN, and kinetics of infection and disease in renal transplantation recipients.
From 2014 to 2018, we conducted a longitudinal cohort observational study of 139 renal transplantation patients treated at a single clinic. Quantitative PCR assay was conducted to assess longitudinal BK viral loads. Analysis of patient clinical characteristics was performed to determine risk factors for BKV infection and associated disease.
Of our cohort, 29 (20.9%) patients developed high BK viremia, and 7 (5.0%) developed biopsy-confirmed BKVN. Clinical parameters associated with diabetes (FBS, HbA1c) and hyperlipidemia (TG, TC, LDL-C) were found to be correlated with development of high BK viremia or BKVN. In 3 of 4 patients receiving intravenous immunoglobulin (IVIG) treatment, BK viral loads were reduced by at least 1 log within 2-3 months of administration. Significant differences were measured in BK viral loads and kidney function between BK viremic patients and BKVN patients by 3-9 months post-transplantation.
We identified diabetes and hyperlipidemia as potential risk factors for development of high BK viremia and/or BKVN. IVIG was seen to be effective in reducing viral titers. The period 3-9 months post-transplantation was identified as important for development of BKVN from high BK viremia.
在肾移植后的免疫功能低下状态下，BK病毒可重新激活并导致BK病毒相关性肾病（BKVN）。BK病毒载量增加和感染持续时间延长与BKVN的发生有关。本研究的目的是观察肾移植受者中BK病毒感染和BKVN的发生率，以及感染和疾病的动态变化。
2014年至2018年，我们对在单一诊所接受治疗的139例肾移植患者进行了纵向队列观察研究。采用定量PCR检测法评估BK病毒载量的动态变化。对患者的临床特征进行分析，以确定BK病毒感染及相关疾病的危险因素。
在我们的队列中，29例（20.9%）患者出现高BK病毒血症，7例（5.0%）患者经活检确诊为BKVN。发现与糖尿病（空腹血糖、糖化血红蛋白）和高脂血症（甘油三酯、总胆固醇、低密度脂蛋白胆固醇）相关的临床参数与高BK病毒血症或BKVN的发生有关。在4例接受静脉注射免疫球蛋白（IVIG）治疗的患者中，有3例在给药后2 - 3个月内BK病毒载量至少降低了1个对数。移植后3 - 9个月，BK病毒血症患者和BKVN患者的BK病毒载量和肾功能存在显著差异。
我们确定糖尿病和高脂血症是发生高BK病毒血症和/或BKVN的潜在危险因素。IVIG被证明可有效降低病毒滴度。移植后3 - 9个月被确定为从高BK病毒血症发展为BKVN的重要时期。
