Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Department of Urology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Transpl Immunol. 2022 Oct;74:101667. doi: 10.1016/j.trim.2022.101667. Epub 2022 Jul 12.
There is a lack of epidemiological studies on the course and clinical characteristics of Parvovirus B19 (B19V) infections in kidney transplant (KT) recipients. This study was undertaken to provide recommendations for clinical B19V infection diagnosis and treatment.
Serum samples of KT recipients were regularly collected and tested for B19V-DNA copies, B19V-IgG/IgM levels, as well as hematological parameters and functions of kidney and liver. The course of B19V infection was described according to the results of serology and DNA testing, and the clinical and epidemiological data were combined for analysis.
75% B19V infections occurred within 2 weeks after KT(n = 9). The infection rate of B19V in KT recipients was high, namely 10.17% (n = 12). The number of 10 patients IgM antibodies against B19V (IgM+) and theDNA B19V (DNA+), whereas 2 patients were IgM negative (IgM-) but DNA+. The B19V infected KT patients showed several symptoms, including anemia (100%), reduction of platelets (8.33%), and damage to liver (75%) and kidney function (16.67%) Patients with progressive anemia in the first two weeks after KT, which combined with the decrease of reticulocytes, are more likely to have B19V infection. Associations of four main therapeutic risk factors for B19V infections in KT patients have been analyzed. B19V infection was associated with use of basiliximab (OR = 1.19; 95%- CI: 1.08-1.32; P = 0.003) and use of thymoglobulins (OR = 0.84; 95%-CI: 0.76-0.93; P = 0.003).
Doctors should be alert to B19V infection, especially in the immunodeficient patients within the first two weeks after transplantation.
目前，关于肾移植（KT）受者细小病毒 B19（B19V）感染的病程和临床特征，缺乏相关的流行病学研究。本研究旨在为临床 B19V 感染的诊断和治疗提供建议。
定期采集 KT 受者的血清样本，检测 B19V-DNA 拷贝数、B19V-IgG/IgM 水平以及肝肾功能的血液学参数。根据血清学和 DNA 检测结果描述 B19V 感染的病程，并结合临床和流行病学数据进行分析。
75%的 B19V 感染发生在 KT 后 2 周内（n=9）。KT 受者的 B19V 感染率较高，为 10.17%（n=12）。10 例患者的 B19V 免疫球蛋白 M（IgM）抗体（IgM+）和 B19V-DNA（DNA+）阳性，而 2 例患者的 IgM 抗体阴性（IgM-）但 DNA+。B19V 感染的 KT 患者表现出多种症状，包括贫血（100%）、血小板减少（8.33%）、肝损伤（75%）和肾功能损伤（16.67%）。在 KT 后两周内出现进行性贫血且网织红细胞减少的患者，更有可能发生 B19V 感染。对 KT 患者中与 B19V 感染相关的 4 个主要治疗风险因素进行了分析。结果显示，巴利昔单抗（OR=1.19；95%CI：1.08-1.32；P=0.003）和胸腺球蛋白（OR=0.84；95%CI：0.76-0.93；P=0.003）的使用与 B19V 感染相关。
医生应警惕 B19V 感染，尤其是在移植后两周内免疫功能低下的患者。
