Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China.
Pediatr Nephrol. 2024 Dec;39(12):3559-3567. doi: 10.1007/s00467-024-06473-8. Epub 2024 Aug 1.
BK polyomavirus (BKV) infection is a critical complication hindering graft survival after kidney transplantation. We aimed to investigate the risk factors and outcome of BKV infection in pediatric kidney transplantation.
The clinical and follow-up data of pediatric kidney transplant recipients at the Children's Hospital of Fudan University from Jan 2015 to June 2023 were retrospectively analyzed.
A total of 217 patients were included in the study with mean follow-up time of 24.3 ± 19.9 months. The mean age at transplantation was 9.7 ± 4.2 years. The patient survival rate and graft survival rate were 98.2% and 96.8%, respectively. Twenty-nine patients (13.4%) developed BKV infection, which was detected at 5.8 ± 3.2 months after transplantation. Among these 29 patients with BKV infection, 8 patients (3.6%) developed BKV nephropathy (BKVN), which was diagnosed at 8.3 ± 2.9 months after transplantation, and 2 patients developed graft failure eventually. Compared with the non-BKV infection group (eGFR 76.7 ± 26.1 mL/min/1.73 m) and BKV infection without BKVN group (eGFR 85.2 ± 23.8 mL/min/1.73 m), BKVN group had lowest eGFR during follow-up (33.5 ± 11.0 ml/min/1.73 m, P < 0.001). Younger age at transplant (OR 0.850, 95%CI 0.762-0.948, P = 0.005), CAKUT disease of primary etiology (OR 2.890, 95%CI 1.200-6.961, P = 0.018), and CMV negative recipient serostatus before transplantation (OR 3.698, 95%CI 1.583-8.640, P = 0.003) were independent risk factors for BKV infection.
Incidence of BKV infection is quite high within 12 months after pediatric kidney transplantation and children with BKVN have poor graft function. Younger age at transplant, CAKUT disease, and CMV negative recipient serostatus before transplantation increase the risk of BKV infection after kidney transplantation.
BK 多瘤病毒（BKV）感染是肾移植后影响移植物存活的严重并发症。本研究旨在探讨儿童肾移植后 BKV 感染的危险因素及结局。
回顾性分析复旦大学附属儿科医院 2015 年 1 月至 2023 年 6 月期间的儿童肾移植受者的临床和随访资料。
本研究共纳入 217 例患者，平均随访时间为 24.3±19.9 个月。移植时的平均年龄为 9.7±4.2 岁。患者生存率和移植物生存率分别为 98.2%和 96.8%。29 例（13.4%）发生 BKV 感染，于移植后 5.8±3.2 个月时检测到。在这 29 例 BKV 感染患者中，8 例（3.6%）发生 BKV 肾病（BKVN），于移植后 8.3±2.9 个月时诊断，最终 2 例发生移植物失功。与非 BKV 感染组（eGFR 76.7±26.1 mL/min/1.73 m）和无 BKVN 的 BKV 感染组（eGFR 85.2±23.8 mL/min/1.73 m）相比，BKVN 组在随访期间的 eGFR 最低（33.5±11.0 mL/min/1.73 m，P<0.001）。移植时年龄较小（OR 0.850，95%CI 0.762-0.948，P=0.005）、原发病为 CAKUT（OR 2.890，95%CI 1.200-6.961，P=0.018）和移植前受者 CMV 阴性（OR 3.698，95%CI 1.583-8.640，P=0.003）是 BKV 感染的独立危险因素。
儿童肾移植后 12 个月内 BKV 感染的发生率相当高，且伴有 BKVN 的患儿移植物功能较差。移植时年龄较小、CAKUT 疾病和移植前 CMV 阴性受者血清状态增加了肾移植后 BKV 感染的风险。
