Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Unidade de Transplantação Renal, Serviço de Nefrologia, Carnaxide, Portugal.
Hospital do Divino Espírito Santo, Serviço de Nefrologia, Ponta Delgada, Portugal.
J Bras Nefrol. 2022 Jul-Sep;44(3):368-375. doi: 10.1590/2175-8239-JBN-2021-0148.
Few studies have investigated pre-donation factors that could affect renal recovery after living kidney donation (LKD). We retrospectively investigated the role of John Cunningham virus (JCV) infection and other pre-donation factors on the magnitude of kidney function decline after LKD.
Urine JCV viral loads, glomerular filtration rate, and blood pressure were evaluated in 60 consecutive LK donors before donation. Suboptimal compensatory hypertrophy was defined as an eGFR <60% of the pre-donation eGFR.
LKD (40% JCV infected) were followed for 3.2±1.6 years. No association was found between age, gender, and baseline hypertension with 1st, 2nd, 3rd, and 4th years post-donation eGFR <60% of the pre-donation eGFR. Mean eGFR recovery at the 3rd year after donation was lower in JCV infected donors vs non-infected donors (61.8% vs 71.0%, p=0.006).
We hypothesized that JCV could shift glomeruli into a hyperfiltration state before nephrectomy, modulating the magnitude of compensatory hypertrophy after donation. Conversely, JCV might curtail the ability of the remaining kidney to promote hyperfiltration. Longer follow up is needed to determine whether JCV viruria ultimately leads to lower eGFR over time or if it is a protective factor for the remaining kidney.
鲜有研究调查过活体供肾（LKD）后影响肾脏恢复的术前因素。我们回顾性研究了 JC 病毒（JCV）感染和其他术前因素对 LKD 后肾功能下降幅度的影响。
在 60 例连续的 LKD 供者术前评估了尿液 JCV 病毒载量、肾小球滤过率和血压。定义肾小球代偿性肥大不足为 eGFR<术前 eGFR 的 60%。
对 LKD（40% JCV 感染）供者随访 3.2±1.6 年。年龄、性别和基线高血压与第 1、2、3 和 4 年 eGFR<术前 eGFR 的 60%均无相关性。与未感染供者相比，JCV 感染供者在术后第 3 年 eGFR 恢复均值较低（61.8%vs71.0%，p=0.006）。
我们推测 JCV 可能在肾切除术前使肾小球进入高滤过状态，从而调节供肾后代偿性肥大的幅度。相反，JCV 可能会削弱剩余肾脏促进高滤过的能力。需要更长时间的随访来确定 JCV 尿病毒载量是否最终导致 eGFR 随时间下降，还是剩余肾脏的保护因素。
