Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Division of Endocrinology, Diabetes, Metabolism & Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Clin Transplant. 2023 Nov;37(11):e15135. doi: 10.1111/ctr.15135. Epub 2023 Sep 13.
BK polyomavirus (BKV) infection is a common complication of kidney transplantation. While BKV has been described in non-kidney transplant recipients, data are limited regarding its epidemiology and outcomes in pancreas transplant recipients.
We conducted a retrospective cohort study of adults who underwent pancreas transplantation from 2010-2020. The primary outcome was BKV DNAemia. Secondary outcomes were estimated glomerular filtration rate (eGFR) reduction by 30%, eGFR < 30 mL/min/1.73 m , endstage kidney disease, and pancreas allograft failure. Cox regression with time-dependent variables was utilized.
Four hundred and sixty-six patients were analyzed, including 74, 46, and 346 with pancreas transplant alone (PTA), pancreas-after-kidney, or simultaneous pancreas-kidney transplants, respectively. PTA recipients experienced a lower incidence of BKV DNAemia (8.8% vs. 32.9%; p < .001) and shorter duration of DNAemia (median 28.0 vs. 84.5 days). No PTA recipients with BKV DNAemia underwent kidney biopsy or developed endstage kidney disease. Lymphopenia, non-PTA transplantation, and older age were associated with BKV DNAemia, which itself was associated with pancreas allograft failure (adjusted hazard ratio 2.14, 95% confidence interval 1.27-3.60; p = .004). Among PTA recipients, BKV DNAemia was not associated with eGFR reduction or eGFR < 30 mL/min/1.73 m .
BKV DNAemia was common among PTA recipients, though lower than a comparable group of pancreas-kidney recipients. However, BKV DNAemia was not associated with adverse native kidney outcomes and no PTA recipients developed endstage kidney disease. Conversely, BKV DNAemia was associated with pancreas allograft failure. Further studies are needed to estimate the rate of BKV nephropathy in this population, and further evaluate long-term kidney outcomes.
BK 多瘤病毒（BKV）感染是肾移植的常见并发症。虽然 BKV 已在非肾移植受者中描述过，但关于其在胰腺移植受者中的流行病学和结局的数据有限。
我们对 2010 年至 2020 年间接受胰腺移植的成年人进行了回顾性队列研究。主要结局是 BKV DNA 血症。次要结局是肾小球滤过率（eGFR）下降 30%、eGFR<30 mL/min/1.73 m 、终末期肾病和胰腺移植物衰竭。采用具有时间依赖性变量的 Cox 回归。
共分析了 466 例患者，分别为单纯胰腺移植（PTA）、胰腺-肾后或同时胰腺-肾移植患者 74、46 和 346 例。PTA 受者 BKV DNA 血症发生率较低（8.8%比 32.9%；p<0.001），DNA 血症持续时间较短（中位数 28.0 比 84.5 天）。无 PTA 受者因 BKV DNA 血症行肾活检或发生终末期肾病。淋巴细胞减少、非 PTA 移植和年龄较大与 BKV DNA 血症相关，BKV DNA 血症本身与胰腺移植物衰竭相关（调整后的危险比 2.14，95%置信区间 1.27-3.60；p=0.004）。在 PTA 受者中，BKV DNA 血症与 eGFR 下降或 eGFR<30 mL/min/1.73 m 无关。
BKV DNA 血症在 PTA 受者中很常见，但低于可比的胰腺-肾移植受者。然而，BKV DNA 血症与原发性肾脏不良结局无关，也没有 PTA 受者发展为终末期肾病。相反，BKV DNA 血症与胰腺移植物衰竭相关。需要进一步研究来估计该人群中 BKV 肾病的发生率，并进一步评估长期肾脏结局。
