Breyer Isabel, Ptak Lucy, Stoy David, Mandelbrot Didier, Parajuli Sandesh
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Transpl Infect Dis. 2024 Dec;26(6):e14371. doi: 10.1111/tid.14371. Epub 2024 Sep 3.
BK polyomavirus (BKPyV)-DNAemia is a common complication in kidney transplant recipients (KTRs). The significance of achieving viral clearance at different time intervals is not well understood.
All adult KTRs transplanted between January 1, 2015 and December 31, 2017 who developed BKPyV-DNAemia were included. Outcomes were analyzed based on persistent clearance of BKPyV-DNAemia at 3-month intervals up to 2 years after initial detection, and for recipients with persistent BKPyV-DNAemia at last follow-up. Uncensored graft failure, death-censored graft failure (DCGF), and a composite outcome of DCGF or fall in estimated glomerular filtration rate (eGFR) by ≥50% from the time of initial BKPyV-DNAemia were outcomes of interest.
Of 224 KTRs with BKPyV-DNAemia, 58 recipients (26%) achieved viral clearance by 3 months after initial detection, 105 (47%) by 6 months, 120 (54%) by 9 months, 141 (63%) by 12 months, 155 (69%) by 15 months, 167 (75%) by 18 months, 180 (80%) by 21 months, and 193 (86%) by 24 months. Nine recipients (4%) had persistent BKPyV-DNAemia at last follow-up. Compared to recipients who achieved viral clearance by 3 months, those who achieved clearance by 6 months (adjusted odds ratio [aOR]: 3.15; 95% confidence interval [CI]: 1.22-8.12; p = .02) and 9 months (aOR: 3.69; 95% CI: 1.02-13.43; p = .04) had significantly increased risk for uncensored graft failure. There was no significant association between time to viral clearance and DCGF or composite outcomes.
We found a trend of increased risk for uncensored graft failure among those who cleared BKPyV-DNAemia more slowly. Aiming to clear viremia early, without risking rejection, may be beneficial for allograft function and patient morbidity and mortality.
BK多瘤病毒（BKPyV）血症是肾移植受者（KTRs）常见的并发症。在不同时间间隔实现病毒清除的意义尚未完全明确。
纳入2015年1月1日至2017年12月31日期间接受移植且发生BKPyV血症的所有成年KTRs。根据初次检测后长达2年的每3个月间隔时BKPyV血症的持续清除情况，以及最后一次随访时持续存在BKPyV血症的受者情况分析结局。未删失的移植失败、死亡删失的移植失败（DCGF），以及从初次BKPyV血症发生时起DCGF或估计肾小球滤过率（eGFR）下降≥50%的复合结局是感兴趣的结局。
在224例发生BKPyV血症的KTRs中，58例受者（26%）在初次检测后3个月内实现病毒清除，105例（47%）在6个月内，120例（54%）在9个月内，141例（63%）在12个月内，155例（69%）在15个月内，167例（75%）在18个月内，180例（80%）在21个月内，193例（86%）在24个月内。9例受者（4%）在最后一次随访时持续存在BKPyV血症。与在3个月内实现病毒清除的受者相比，在6个月（校正比值比[aOR]：3.15；95%置信区间[CI]：1.22 - 8.12；p = 0.02）和9个月（aOR：3.69；95% CI：1.02 - 13.43；p = 0.04）实现清除的受者未删失的移植失败风险显著增加。病毒清除时间与DCGF或复合结局之间无显著关联。
我们发现BKPyV血症清除较慢的受者未删失的移植失败风险有增加趋势。在不冒排斥风险的情况下尽早清除病毒血症，可能对同种异体移植功能以及患者的发病率和死亡率有益。
