Infectious Disease Department, APHP-Saint Louis Hospital, 1 Avenue Claude Vellefaux, Paris, France.
INSERM U944, «Biology of Emerging Viruses» Team, Institut de Recherche Saint Louis, APHP-Saint Louis Hospital, Paris, France.
BMC Infect Dis. 2023 Feb 6;23(1):74. doi: 10.1186/s12879-023-08043-z.
Following kidney transplantation, BK virus associated nephropathy (BKVN) occurs in 1 to 10% of kidney transplant recipients (KTR) and represents a major cause of graft loss. We aim at identifying factors associated with biopsy proven BKVN among KTR.
We conducted a retrospective case-control study including all KTR with a biopsy-proven diagnosis of BKVN between 2005 and 2019. Clinical characteristics and outcome were described. For each case, one control KTR without BKV infection was identified and matched by age, transplant date, and donor status. Factors associated with BKVN diagnosis were identified using exact conditional logistic regression. Comparative survival was described using Kaplan-Meier estimator.
Sixty-four cases of BKVN were identified among 1737 new kidney transplantation (3.7% prevalence). Clinical characteristics did not differ between groups, except for a higher c-PRA among cases. BKVN occurred in a median time of 11 (5-14.5) months after KT, and was associated with a significantly impaired graft function at diagnosis. Following BKVN, 61 (95%) of the patients had immunosuppression reduction, which led to BKV DNAemia resolution in 49% of cases. In multivariate analysis, factors associated with BKVN diagnosis were lymphopenia < 500/mm and a prednisone dose > 7.5 mg/day. Median duration of follow-up was 40 months for both groups. BKVN was associated with a significantly increased risk of graft rejection (P = 0.02) and return to dialysis (P = 0.01).
BKVN remains a severe complication in KTR and is associated with an increased risk for acute rejection and return to dialysis. Lymphopenia below 500/mm and corticosteroid maintenance therapy are significantly associated with biopsy-proven BKVN diagnosis.
BK 病毒相关性肾病（BKVN）在 1%至 10%的肾移植受者（KTR）中发生，是移植物丢失的主要原因。我们旨在确定 KTR 中经活检证实的 BKVN 相关因素。
我们进行了一项回顾性病例对照研究，纳入了 2005 年至 2019 年间所有经活检证实为 BKVN 的 KTR。描述了临床特征和结局。为每个病例，通过年龄、移植日期和供体状态匹配了一名未感染 BKV 的对照 KTR。使用精确条件逻辑回归确定与 BKVN 诊断相关的因素。使用 Kaplan-Meier 估计器描述比较生存情况。
在 1737 例新肾移植中，共发现 64 例 BKVN（患病率为 3.7%）。两组之间的临床特征无差异，除了病例组的 c-PRA 较高。BKVN 发生在 KT 后 11（5-14.5）个月中位数时间，且在诊断时与显著受损的移植物功能相关。BKVN 后，61（95%）例患者进行了免疫抑制药物减量，导致 49%的病例 BKV DNA 血症缓解。多变量分析表明，与 BKVN 诊断相关的因素是淋巴细胞计数 < 500/mm 和泼尼松剂量 > 7.5mg/天。两组的中位随访时间均为 40 个月。BKVN 与移植物排斥反应（P = 0.02）和返回透析（P = 0.01）的风险显著增加相关。
BKVN 仍然是 KTR 的严重并发症，与急性排斥反应和返回透析的风险增加相关。淋巴细胞计数 < 500/mm 和皮质类固醇维持治疗与经活检证实的 BKVN 诊断显著相关。
