Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Transpl Int. 2021 Dec;34(12):2680-2685. doi: 10.1111/tri.14134. Epub 2021 Oct 28.
BK polyomavirus (BKPyV) reactivation is regularly monitored after kidney transplant to prevent progression to BK associated nephropathy (BKAN). The New England BK Consortium, made up of 12 transplant centres in the northeastern United States, conducted a quality improvement project to examine adherence to an agreed upon protocol for BKPyV screening for kidney transplants performed in calendar years 2016-2017. In a total of 1047 kidney transplant recipients (KTR) from 11 transplant centres, 204 (19%) had BKPyV infection, defined as detection of BKPyV in plasma, with 41 (4%) KTR progressing to BKAN, defined by either evidence on biopsy tissues or as determined by treating nephrologists. BKPyV infection was treated with reduction of immune suppressants (RIS) in >70% of the patients in all but two centres. There was no graft loss because of BKAN during the two-year follow-up. There were nine cases of post-RIS acute rejection detected during this same period. Adherence to the protocol was low with 54% at 12 months and 38% at 24 months, reflecting challenges of managing transplant patients at all centres. The adherence rate was positively correlated to increased detection of BKPyV infection and was unexpectedly positively correlated to an increase in diagnosis of BKAN.
BK 多瘤病毒（BKPyV）在肾移植后经常被监测，以防止进展为 BK 相关肾病（BKAN）。由美国东北部 12 个移植中心组成的新英格兰 BK 联合会，开展了一项质量改进项目，以检查在 2016-2017 年进行的肾移植中对 BKPyV 筛查的既定方案的遵守情况。在总共 11 个移植中心的 1047 名肾移植受者（KTR）中，有 204 名（19%）发生 BKPyV 感染，定义为在血浆中检测到 BKPyV，其中 41 名（4%）KTR 进展为 BKAN，通过活检组织或由治疗肾病学家确定。除了两个中心外，所有患者中超过 70%的患者通过减少免疫抑制剂（RIS）治疗 BKPyV 感染。在两年的随访中，没有因 BKAN 而导致移植物丢失。在此期间还发现了 9 例 RIS 后急性排斥反应病例。在 12 个月时，遵守该方案的比例为 54%，在 24 个月时为 38%，这反映了所有中心在管理移植患者方面的挑战。该遵守率与 BKPyV 感染的检测增加呈正相关，且出人意料地与 BKAN 的诊断增加呈正相关。
