Division of General Internal Medicine, Nephrology and Rheumatology, Department of Medicine D, University Hospital of Münster, 48149, Münster, Germany.
Department of Internal Medicine and Nephrology, University Hospital of Münster Marienhospital Steinfurt, 48565, Steinfurt, Germany.
Sci Rep. 2020 Dec 29;10(1):22406. doi: 10.1038/s41598-020-79799-6.
BK polyomavirus (BKPyV) and cytomegalovirus (CMV) are the main viral pathogens affecting the graft and recipient outcome after allogenic kidney transplantation. It has recently been found that infection with both viruses has a greater impact on kidney graft function than a single infection. We retrospectively analyzed a cohort of 723 recipients who received kidney transplantation between 2007 and 2015 after living and postmortal donation for differences in risk and outcome parameters regarding BKPyV (DNAemia) and CMV (CMV DNAemia) co-infection compared to sole viremias and to patients without viremia. Of all kidney allograft recipients in our cohort, 8.2% developed co-infection with BKPyV DNAemia and CMV DNAemia, 15.1% showed BKPyV viremia alone and 25.2% sole CMV DNAemia. Acute rejection was closely linked with co-infection (multivariable analysis, p = 0.001). Despite the fact that the estimated glomerular filtration rate of patients with co-infection was noticeably reduced compared to patients with BKV or CMV infection alone, transplant survival and patient survival were not significantly reduced. Co-infection with BKPyV and CMV in kidney transplanted patients is significantly associated with inferior allograft function. Since co-infection is strongly associated with acute rejection, co-infected individuals should be considered a risk collective.
BK 多瘤病毒（BKPyV）和巨细胞病毒（CMV）是影响同种异体肾移植后移植物和受者结局的主要病毒病原体。最近发现，两种病毒的感染对肾脏移植物功能的影响大于单一感染。我们回顾性分析了 723 例于 2007 年至 2015 年期间接受活体和死后供体肾移植的受者，比较 BKPyV（DNAemia）和 CMV（CMV DNAemia）合并感染与单纯病毒血症及无病毒血症患者在风险和结局参数方面的差异。在我们的队列中，所有肾移植受者中，8.2%发生 BKPyV DNAemia 和 CMV DNAemia 合并感染，15.1%出现单纯 BKPyV 病毒血症，25.2%出现单纯 CMV DNAemia。急性排斥反应与合并感染密切相关（多变量分析，p=0.001）。尽管合并感染患者的估算肾小球滤过率明显低于单纯 BKPyV 或 CMV 感染患者，但移植存活率和患者存活率无显著降低。肾移植患者 BKPyV 和 CMV 合并感染与移植物功能受损显著相关。由于合并感染与急性排斥反应密切相关，因此应将合并感染者视为高危人群。
