Vela Carla, Jouve Thomas, Chevallier Eloi, Imerzoukene Farida, Germi Raphaële, Le Marechal Marion, Truffot Aurélie, Fiard Gaëlle, Janbon Bénédicte, Giovannini Diane, Malvezzi Paolo, Rostaing Lionel, Noble Johan
Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, France.
Medicine Faculty, University of Grenoble Alpes, 38000 Grenoble, France.
J Clin Med. 2022 Dec 8;11(24):7292. doi: 10.3390/jcm11247292.
BK virus-associated nephropathy (PvAN) increases the risk of graft failure justifying treatment. Conversion to mammalian target of rapamycin inhibitors (mTORi) and Human polyclonal immunoglobulins (IVIg) could prevent the risk of PvAN. Our retrospective study assessed the efficacy of mTORi associated with IVIg therapy (mTORi±IVIg group) versus standard immunosuppression reduction to clear BKV DNAemia. Among forty-three kidney-transplanted patients with positive BKV DNAemia, we included twenty-six patients in the mTORi±IVIg group and reduced immunosuppression therapy for seventeen patients. We focused on BKV DNAemia clearance on the first-year. Renal function, rejection rate, evolution to PvAN, and complications of immunosuppression were assessed. BKV DNAemia decreased faster and significantly in the control group as compared to the mTORi±IVIg group (p < 0.001). Viral clearance was significantly higher in the control group compared to the mTORi±IVIg group (88% vs. 58%; p = 0.033). Death-censored graft loss, rejection rates and kidney-graft function at 12 months did not significantly differ. Multivariate analyses significantly associated BKV DNAemia clearance with reducing immunosuppression (OR = 0.11 (0.06−0.9), p = 0.045), female kidney donor (OR = 0.10 (0.01−0.59/)], p = 0.018) and time to first DNAemia, (OR = 0.88 (0.76−0.96), p = 0.019). In our study, the standard treatment for BKV DNAemia had better outcomes than an mTORi±IVIg conversion.
BK病毒相关性肾病（PVAN）会增加移植失败的风险，因此有必要进行治疗。转换为雷帕霉素靶蛋白抑制剂（mTORi）和人多克隆免疫球蛋白（IVIg）可以预防PVAN的风险。我们的回顾性研究评估了mTORi联合IVIg治疗（mTORi±IVIg组）与标准免疫抑制减量治疗清除BK病毒血症的疗效。在43例BK病毒血症阳性的肾移植患者中，我们将26例患者纳入mTORi±IVIg组，并对17例患者进行免疫抑制治疗减量。我们重点观察了第一年的BK病毒血症清除情况。评估了肾功能、排斥反应发生率、向PVAN的进展情况以及免疫抑制的并发症。与mTORi±IVIg组相比，对照组的BK病毒血症下降更快且更显著（p<0.001）。与mTORi±IVIg组相比，对照组的病毒清除率显著更高（88%对58%；p=0.033）。12个月时的死亡删失移植肾丢失、排斥反应发生率和移植肾功能无显著差异。多因素分析显示，BK病毒血症清除与免疫抑制减量（比值比[OR]=0.11[0.06−0.9]，p=0.045）、女性供肾（OR=0.10[0.01−0.59]，p=0.018）以及首次出现病毒血症的时间（OR=0.88[0.76−0.96]，p=0.019）显著相关。在我们的研究中，BK病毒血症的标准治疗比mTORi±IVIg转换治疗的效果更好。
