Nguyen Kaitlin, Diamond Adam, Carlo Antonio Di, Karhadkar Sunil
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Department of Pharmacy, Temple University Hospital, Philadelphia, Pennsylvania.
J Surg Res. 2022 Jan;269:110-118. doi: 10.1016/j.jss.2021.07.047. Epub 2021 Sep 20.
Immunosuppression following kidney transplantation increases risk of BK polyomavirus reactivation, a common cause of graft dysfunction and failure. Subsequent retransplantation is a viable option that has not been extensively studied. This study further characterizes BK Virus Nephropathy (BKVN) and retransplantation in the most expansive population to date, geographically, temporally, and in magnitude.
The OPTN/UNOS database was used to identify patients who received kidney or kidney-pancreas transplantation between 1987 and 2018 that resulted in BKVN-attributed failure (n = 1587). This population was divided into those who underwent retransplantation (n = 495) and those who did not (n = 1092).
The retransplanted cohort was younger (45 vs. 53 yr; P<0.0001) and had fewer prior kidney transplants (P<0.003), lower expected post-transplant survival (P<0.001), lower rates of delayed graft function (DGF) (14.1% vs. 22.2%; P=0.0008), a greater proportion of white patients (55.4% vs. 43.2%; P=0.0002), a greater proportion of living donors (35.8% vs. 23.0%; P<0.0001), and longer allograft lifespan (2.95 vs. 2.41 yr; P<0.0001), compared to those not retransplanted. Among retransplants, DGF and high kidney donor profile index (KDPI) were associated with decreased allograft lifespan (P=0.001, P=0.0005, respectively). Steroid induction had no effect on allograft lifespan when compared to steroid-free regimens (P=0.915). Retransplanted allografts lasted longer than previous BKVN-failed grafts (10.44 and 3.70 years, respectively; P<0.0001).
Retransplantation following BKVN-associated graft failure has been associated with favorable outcomes. To maximize allograft lifespan in retransplantation, clinicians may consider selection of low KDPI donors, prevention of delayed graft function, and tailored immunosuppressive regimens that minimize steroids.
肾移植后的免疫抑制会增加BK多瘤病毒再激活的风险，这是移植肾功能障碍和衰竭的常见原因。随后的再次移植是一种可行的选择，但尚未得到广泛研究。本研究在迄今为止地域、时间和规模上最广泛的人群中，进一步对BK病毒肾病（BKVN）和再次移植进行了特征描述。
使用器官获取与移植网络/美国器官共享联合网络（OPTN/UNOS）数据库，识别1987年至2018年间接受肾或肾胰联合移植且因BKVN导致移植失败的患者（n = 1587）。该人群分为接受再次移植的患者（n = 495）和未接受再次移植的患者（n = 1092）。
与未接受再次移植的患者相比，再次移植队列的患者更年轻（45岁对53岁；P<0.0001），既往肾移植次数更少（P<0.003），移植后预期生存期更低（P<0.001），移植肾功能延迟恢复（DGF）发生率更低（14.1%对22.2%；P = 0.0008），白人患者比例更高（55.4%对43.2%；P = 0.0002），活体供者比例更高（35.8%对23.0%；P<0.0001），移植肾存活时间更长（2.95年对2.41年；P<0.0001）。在再次移植患者中，DGF和高肾供体风险指数（KDPI）与移植肾存活时间缩短相关（分别为P = 0.001，P = 0.0005）。与无类固醇方案相比，类固醇诱导对移植肾存活时间无影响（P = 0.915）。再次移植的移植肾存活时间比之前因BKVN失败的移植肾更长（分别为10.44年和3.70年；P<0.0001）。
BKVN相关移植失败后的再次移植与良好的预后相关。为了在再次移植中最大化移植肾存活时间，临床医生可以考虑选择低KDPI供者、预防移植肾功能延迟恢复以及采用使类固醇用量最小化的个体化免疫抑制方案。
