Schoephoerster Jamee, Jensen Chelsey, Jackson Scott, Plautz Emilee, Balani Shanthi, Kouri Anne, Kizilbash Sarah J
University of Minnesota, Minneapolis, Minnesota, USA.
Solid Organ Transplant, University of Minnesota, Minneapolis, Minnesota, USA.
Pediatr Transplant. 2023 Feb;27(1):e14372. doi: 10.1111/petr.14372. Epub 2022 Aug 8.
Pediatric data on risk factors and the clinical course of BK DNAemia are limited. We aimed to determine the effects of BK DNAemia on transplant outcomes and delineate the safety and efficacy of various treatment approaches.
This retrospective-cohort study included 161 transplants (age ≤ 21 years) performed at a single center between 1/1/2012 and 1/1/2020. We used Cox proportional models to evaluate the effects of BK DNAemia on patient survival (PS), graft survival (GS), and acute rejection (AR), using BK as a time-dependent covariate. We also assessed the effects of pharmacological intervention on BK DNAemia duration using intervention as a time-dependent covariate.
BK-free survival was 69.1% at 1-year and 54.6% at 3-year posttransplant. After multivariate adjustment, BK DNAemia was associated with young age at transplant (aHR, age 5-<12 vs. ≥12 (years): 2.5 (1.4-4.5); p = .001) and steroid-based immunosuppression (IS) (aHR: 2.2 [1.1-4.5]; p = .03). We found no effect of DNAemia on AR (aHR: 1.25; p = .5), PS (aHR: 2.85; p = .22), and GS (aHR: 0.56; p = .41). Of 70 patients with DNAemia, 22 (31.4%) received no treatment, 20 (28.6%) received IS reduction alone, and 28 patients (40%) received treatment with at least one pharmacological agent (leflunomide, IVIG, ciprofloxacin, cidofovir). Sixty-three patients (90%) cleared DNAemia with median time to resolution of 2.4 months (IQR:1.4-5.6). We found no significant effect of BK-directed pharmacological treatment on time to resolution (aHR: 0.64;p = .13). BK-directed agents were well tolerated.
BK DNAemia is associated with a young age at transplant and steroid-based maintenance IS. We found no effect of BK DNAemia on AR, GS, and PS.
关于BK病毒血症的危险因素和临床病程的儿科数据有限。我们旨在确定BK病毒血症对移植结局的影响，并描述各种治疗方法的安全性和有效性。
这项回顾性队列研究纳入了2012年1月1日至2020年1月1日在单一中心进行的161例移植手术（年龄≤21岁）。我们使用Cox比例模型，将BK作为时间依赖性协变量，评估BK病毒血症对患者生存（PS）、移植物生存（GS）和急性排斥反应（AR）的影响。我们还将干预作为时间依赖性协变量，评估药物干预对BK病毒血症持续时间的影响。
移植后1年无BK病毒血症的生存率为69.1%，3年为54.6%。多因素调整后，BK病毒血症与移植时年龄较小（调整后风险比，5-<12岁与≥12岁（岁）：2.5（1.4-4.5）；p = 0.001）和基于类固醇的免疫抑制（IS）相关（调整后风险比：2.2 [1.1-4.5]；p = 0.03）。我们发现病毒血症对AR（调整后风险比：1.25；p = 0.5）、PS（调整后风险比：2.85；p = 0.22）和GS（调整后风险比：0.56；p = 0.41）没有影响。在70例有病毒血症的患者中，22例（31.4%）未接受治疗，20例（28.6%）仅接受免疫抑制减少治疗，28例（40%）接受了至少一种药物（来氟米特、静脉注射免疫球蛋白、环丙沙星、西多福韦）治疗。63例（90%）患者病毒血症清除，中位清除时间为2.4个月（四分位间距：1.4-5.6）。我们发现针对BK的药物治疗对清除时间没有显著影响（调整后风险比：0.64；p = 0.13）。针对BK的药物耐受性良好。
BK病毒血症与移植时年龄较小和基于类固醇的维持免疫抑制有关。我们发现BK病毒血症对AR、GS和PS没有影响。
