心脏死亡器官捐献供肾移植受者BK病毒感染的危险因素

Risk factors for BK virus infection in DCD donor kidney transplant recipients.

作者信息

Liu Yiting, Kong Chenyang, Hu Haochong, Zhang Yalong, Wang Tianyu, Qiu Tao, Zhou Jiangqiao

机构信息

Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.

Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.

出版信息

Front Med (Lausanne). 2023 Jul 12;10:1181743. doi: 10.3389/fmed.2023.1181743. eCollection 2023.

DOI:10.3389/fmed.2023.1181743

PMID:37502357

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10368890/

Abstract

BACKGROUND

BK virus infection after kidney transplantation can negatively impact the prognosis of patients. However, current risk factor analyses primarily focus on BK virus nephropathy, while BK viruria and BK viruria progressing to BK viremia receive less attention. This study aims to analyze the risk factors associated with BK viruria and BK viruria progressing to BK viremia in recipients of donation after cardiac death (DCD), with the goal of facilitating early intervention.

METHODS

Donor characteristics and clinical data of recipients before and after transplantation were evaluated, and logistic univariate and multivariate analyses were performed to determine the risk factors associated with BK viruria and the progression of BK viruria to BK viremia. Additionally, machine learning techniques were employed to identify the top five features associated with BK viruria evolving into BK viremia.

RESULTS

During a median follow-up time of 1,072 days (range 739-1,418), 69 transplant recipients (15.6% incidence rate) developed BK viruria after transplantation, with 49.3% of cases occurring within 6 months post-transplantation. Moreover, 19 patients progressed to BK viremia. Donor age [OR: 1.022 (1.000, 1.045), = 0.047] and donor procalcitonin (PCT) levels [0.5-10 ng/ml; OR: 0.482 (0.280, 0.828), = 0.008] were identified as independent risk factors for BK viruria. High BK viruria [OR: 11.641 (1.745, 77.678), = 0.011], recipient age [OR: 1.106 (1.017, 1.202), = 0.018], and immunoinduction regimen [ATG; OR: 0.063 (0.006, 0.683), = 0.023] were independent risk factors for BK viruria progressing to BK viremia. Machine learning analysis confirmed the importance of high BK viruria, recipient age, and immunoinduction regimen (ATG) in predicting the progression of BK viruria to BK viremia.

CONCLUSION

The development and progression of BK virus in DCD kidney transplant recipients is influenced by multiple factors. Early intervention and treatment could potentially extend the lifespan of the transplanted organ.

摘要

背景

肾移植后BK病毒感染会对患者预后产生负面影响。然而，目前的危险因素分析主要集中在BK病毒肾病，而BK病毒尿症以及BK病毒尿症进展为BK病毒血症受到的关注较少。本研究旨在分析心脏死亡后供体肾移植受者中与BK病毒尿症以及BK病毒尿症进展为BK病毒血症相关的危险因素，以便于早期干预。

方法

评估供体特征以及移植前后受者的临床数据，并进行逻辑单因素和多因素分析，以确定与BK病毒尿症以及BK病毒尿症进展为BK病毒血症相关的危险因素。此外，采用机器学习技术来识别与BK病毒尿症演变为BK病毒血症相关的前五项特征。

结果

在中位随访时间1072天（范围739 - 1418天）内，69例移植受者（发病率15.6%）移植后出现BK病毒尿症，其中49.3%的病例发生在移植后6个月内。此外，19例患者进展为BK病毒血症。供体年龄[比值比：1.022（1.000，1.045），P = 0.047]和供体降钙素原（PCT）水平[0.5 - 10 ng/ml；比值比：0.482（0.280，0.828），P = 0.008]被确定为BK病毒尿症的独立危险因素。高BK病毒尿症[比值比：11.641（1.745，77.678），P = 0.011]、受者年龄[比值比：1.106（1.017，1.202），P = 0.018]和免疫诱导方案[抗胸腺细胞球蛋白（ATG）；比值比：0.063（0.006，0.683），P = 0.023]是BK病毒尿症进展为BK病毒血症的独立危险因素。机器学习分析证实了高BK病毒尿症、受者年龄和免疫诱导方案（ATG）在预测BK病毒尿症进展为BK病毒血症方面的重要性。