切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 96 -100. doi: 10.3877/cma.j.issn.1674-3903.2020.02.008

所属专题: 文献

论著

BK病毒血症对肾移植术后受者和移植肾功能影响临床研究
潘国政1, 李势辉1, 戴帅1, 翟凤仙1,()   
  1. 1. 230001 合肥,中国科学技术大学附属第一医院器官移植中心
  • 收稿日期:2019-05-14 出版日期:2020-04-25
  • 通信作者: 翟凤仙
  • 基金资助:
    安徽省自然科学基金(1908085QH354,1908085QH320)

Clinical study on the influence of BK virus viremia on the recipient and the function of transplant kidney after transplantation

Guozheng Pan1, Shihui Li1, Shuai Dai1, Fengxian Zhai1,()   

  1. 1. Deptartment of Organ Transplantation, the First Affiliated Hospital of University of Chinese Academy of Sciences, Hefei 230001, China
  • Received:2019-05-14 Published:2020-04-25
  • Corresponding author: Fengxian Zhai
  • About author:
    Corresponding author: Zhai Fengxian, Email:
引用本文:

潘国政, 李势辉, 戴帅, 翟凤仙. BK病毒血症对肾移植术后受者和移植肾功能影响临床研究[J]. 中华移植杂志(电子版), 2020, 14(02): 96-100.

Guozheng Pan, Shihui Li, Shuai Dai, Fengxian Zhai. Clinical study on the influence of BK virus viremia on the recipient and the function of transplant kidney after transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2020, 14(02): 96-100.

目的

探究肾移植术后BK病毒(BKV)血症对受者及移植肾功能的影响。

方法

回顾性分析2014年1月至2018年1月于中国科学技术大学附属第一医院接受肾移植229例受者临床资料。根据移植术后24个月内受者血清BKV最大载量,将其分为无病毒组(血清BKV持续阴性)、低病毒载量组(血清BKV最大载量≤1×104 copies/mL)和高病毒载量组(血清BKV最大载量>1×104 copies/mL)。以估算肾小球滤过率(eGFR)作为评价移植肾功能的指标。观察受者年龄和性别、供肾来源、供肾冷/热缺血时间、免疫抑制方案、术后3个月他克莫司血药浓度谷值、排斥反应和移植肾失功发生率以及术后24个月内eGFR。采用单因素方差分析比较3组受者年龄、供肾冷/热缺血时间、术后3个月他克莫司血药浓度谷值及术后24个月内eGFR,组间两两比较采用LSD法。采用成组t检验比较低病毒载量组与高病毒载量组受者首次检测到BKV的术后时间。采用卡方检验比较3组受者供肾来源、免疫抑制方案以及排斥反应和移植肾失功发生率。P<0.05为差异有统计学意义。

结果

229例受者中28%(64/229)的受者肾移植术后血清检测到BKV,其中19%(43/229)为低病毒载量,9%(21/229)为高病毒载量。截至2018年7月,229例受者平均随访时间(44±8)个月。低病毒载量组受者术后首次检测到BKV的时间为移植后(10±8)个月,高病毒载量组为(8±6)个月,差异有统计学意义(t=2.10,P<0.05)。无病毒组受者排斥反应发生率[24.8%(41/165)]低于低病毒载量组[60.5%(26/43)]和高病毒载量组[61.9%(13/21)](χ2=19.82和12.42,P均<0.017)。无病毒组受者细胞排斥反应发生率[13.9%(23/165)]低于低病毒载量组[39.5%(17/43)]和高病毒载量组[42.9%(9/21)](χ2=14.38和10.94,P均<0.017)。无病毒组受者中12例发生移植肾失功,低病毒载量组受者中2例发生移植肾失功,高病毒载量组受者中4例(3例发生BKVAN,1例病因不明确)发生移植肾失功,差异无统计学意义(χ2=4.727,P>0.05)。高病毒载量组受者术后第3个月他克莫司血药浓度谷值高于无病毒组和低病毒载量组(P均<0.05)。高病毒载量组受者术后第3、6、12、24个月eGFR均低于无病毒组和低病毒载量组(P均<0.05)。

结论

肾移植术后高BKV血症会影响肾移植受者预后及移植肾功能;而低BKV血症对移植肾功能无明显不良影响,此类受者无需调整他克莫司剂量。

Objective

To explore the effect of BK virus viremia on the recipient and the function of transplant kidney after transplantation.

Methods

The clinical data of 229 recipients who received kidney transplantation in the First Affiliated Hospital of University of Chinese Academy of Sciences were analyzed retrospectively. According to the maximum serum BK virus load within 24 months after transplantation, the recipients were divided into virus-free group (serum BKV continued negative), low virus load group (serum BKV maximum load≤1×104 copies/mL) and high virus load group (serum BKV maximum load>1×104 copies/mL). The estimated glomerular filtration rate (eGFR) was used to evaluate the kidney function. The age and gender of the recipients, the source of the donor kidney, the time of cold/hot ischemia of the donor kidney, the immunosuppressive program, the blood trough concentration of tacrolimus at 3 months after transplantation, the incidence of rejection and graft dysfunction, and the eGFR within 24 months after transplantation was observed. Single factor analysis of variance was used to compare the age of recipients, the time of cold/hot ischemia of donor kidney, the blood trough concentration of tacrolimus at 3 months after transplantation and eGFR in 24 months after transplantation in the 3 groups and that between groups with LSD method. Group t test was used to compare the first detection time of BK virus infection between the low virus load group and the high virus load group. Chi square test was used to compare the source of donor kidney, immunosuppressive regimen, and the incidence of graft failure and rejection. P<0.05 was statistically significant.

Results

BK virus viremia was detected in 64 recipients among 229 recipients (28%), of which 19% (43/229) was low virus load and 9% (21/229) was high virus load. As of July 2018, the average follow-up time of 229 recipients was (44±8) months. The first detection time of BK virus infection was (10±8) months after transplantation in low virus load group and (8±6) months in high virus load group, which had statistical significance (t=2.10, P<0.05). The rejection rate of virus-free group [24.8% (41/165)] was lower than that of low virus load group [60.5% (26/43)] and high virus load group [61.9% (13/21)] (χ2=19.82 and 12.42, P all<0.017). The incidence of cellular rejection in virus-free group [13.9% (23/165)] was lower than that in low virus load group [39.5% (17/43)] and high virus load group [42.9% (9/21)] (χ2=14.38 and 10.94, P<0.017). 12 recipients in the virus-free group, 2 recipients in the low virus load group, 4 recipients in the high virus load group (3 with BK virus associated nephropathy, 1 with unclear etiology) had renal allograft dysfunction, which had no statistical significance (χ2=4.727, P>0.05). The blood trough concentration of tacrolimus at 3 months after transplantation in the high viral load group was higher than that in the virus-free group and the low virus load group (P all<0.05). At the 3th, 6th, 12th and 24th month after operation, eGFR of the recipients in the high virrus load group were all lower than that in the virus-free group and the low virus load group (P all<0.05).

Conclusions

High BK virus viremia after kidney transplantation can significantly affect the prognosis of recipients; low BK virus viremia had no significant adverse effect on the function of transplant kidney, and there was no need to adjust the dosage of tacrolimus for recipients with low BK virus viremia.

表1 无病毒组、低病毒载量组和高病毒载量组肾移植受者一般资料比较
表2 无病毒组、低病毒载量组和高病毒载量组肾移植受者术后3个月他克莫司血药浓度谷值及术后24个月内eGFR比较(±s)
[1]
Kuypers DR. Management of polyomavirus-associated nephropathy in renal transplant recipients[J]. Nat Rev Nephrol, 2012, 8(7): 390-402.
[2]
AST Infectious Diseases Community of Practice; Hirsch HH, Randhawa P. BK polyomavirus in solid organ transplantation[J]. Am J Transplant, 2013,13(Suppl 4): S179-S188.
[3]
Huang G, Zhang L, Liang X, et al. Risk factors for BK virus infection and BK virus-associated nephropathy under the impact of intensive monitoring and pre-emptive immunosuppression reduction[J]. Transplant Proc, 2014, 46(10): 3448-3454.
[4]
孙忠蔚,范宇,柏宏伟,等. 他克莫司代谢率与肾移植术后早期BK病毒感染的关系[J]. 器官移植,2018, 4(9): 278-282.
[5]
Drachenberg CB, Hirsch HH, Papadimitriou JC, et al. Polyomavirus BK versus JC replication and nephropathy in renal transplant recipients: Aprospective evaluation[J]. Transplantation, 2007, 84(3): 323-330.
[6]
范宇,石炳毅,钱叶勇,等. 肾移植术后BK病毒感染对移植肾功能影响的临床研究[J]. 器官移植,2018, 9(1): 51-57.
[7]
Bohl DL, Brennan DC. BK virus nephropathy and kidney transplantation[J]. Clin J Am Soc Nephrol, 2007, 2(Suppl 1):S36-S46.
[8]
Kasiske BL, Zeier MG, Chapman JR, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary[J]. Kidney Int, 2010, 77(4): 299-311.
[9]
Randhawa P, Ho A, Shapiro R, et al. Correlates of quantitative measurement of BK polyomavirus (BKV) DNA with clinical course of BKV infection in renal transplant patients[J]. J Clin Microbiol, 2004, 42(3): 1176-1180.
[10]
Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients[J]. Am J Transplant, 2009, 9(Suppl 3):S1-S155.
[11]
Drachenberg CB, Papadimitriou JC, Hirsch HH, et al. Histological patterns of polyomavirus nephropathy: Correlation with graft outcome and viral load[J]. Am J Transplant, 2004, 4(12): 2082-2092.
[12]
Czyżewski Ł, Wyzgał J, Czyżewska E, et al. Performance of the MDRD, CKD-EPI, and Cockcroft-Gault formulas in relation to nutritional status in stable renal transplant recipients[J]. Transplant Proc, 2016, 48(5): 1494-1497.
[13]
Sawinski D, Goral S. BK virus infection: an update on diagnosis and treatment[J]. Nephrol Dial Transplant, 2015, 30(2): 209-217.
[14]
Sood P, Senanayake S, Sujeet K, et al. Management and outcome of BK viremia in renal transplant recipients: a prospective single-center study[J]. Transplantation, 2012, 94(8): 814-821.
[15]
Elfadawy N, Flechner SM, Schold JD, et al. Transient versus persistent BK viremia and long-term outcomes after kidney and kidney-pancreas transplantation[J]. Clin J Am Soc Nephrol, 2014, 9(3): 553-561.
[16]
Jacobi J, Prignitz A, Büttner M, et al. BK viremia and polyomavirus nephropathy in 352 kidney transplants; risk factors and potential role of mTOR inhibition[J]. BMC Nephrol, 2013, 14: 207
[1] 彭文翰. 肾移植受者早期霉酚酸强化剂量长期有效性和安全性的研究[J]. 中华移植杂志(电子版), 2023, 17(05): 0-.
[2] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会, 上海医药行业协会. 中国肝、肾移植受者霉酚酸类药物应用专家共识(2023版)[J]. 中华移植杂志(电子版), 2023, 17(05): 257-272.
[3] 彭雨诗, 苗芸, 严紫嫣. 宏基因组高通量测序诊断肾移植术后华支睾吸虫感染一例[J]. 中华移植杂志(电子版), 2023, 17(05): 297-299.
[4] 戚若晨, 马帅军, 韩士超, 王国辉, 刘克普, 张小燕, 杨晓剑, 秦卫军. 肾移植术后新型冠状病毒感染单中心诊疗经验[J]. 中华移植杂志(电子版), 2023, 17(04): 232-239.
[5] 胡皓翀, 刘一霆, 郭嘉瑜, 邹寄林, 陈忠宝, 周江桥, 邱涛. 肾移植术后耐碳青霉烯类肺炎克雷伯菌感染的诊疗分析[J]. 中华移植杂志(电子版), 2023, 17(04): 246-249.
[6] 朱伟芳, 陈琳, 乔建军. 激光联合光动力疗法治疗肾移植后鲍恩样丘疹病一例[J]. 中华移植杂志(电子版), 2023, 17(04): 250-252.
[7] 吴建永. 单中心2 000例心脏死亡器官捐献肾移植发展与创新[J]. 中华移植杂志(电子版), 2023, 17(04): 0-.
[8] 刘路浩, 苏泳鑫, 曾丽娟, 张鹏, 陈荣鑫, 徐璐, 李光辉, 方佳丽, 马俊杰, 陈正. 新型冠状病毒感染疫情期间肾移植受者免疫抑制剂服药依从性研究[J]. 中华移植杂志(电子版), 2023, 17(03): 140-145.
[9] 张亚龙, 邱涛, 刘一霆, 王天宇, 孔晨阳, 喻博, 周江桥. 术前透析方式及时长对肾移植预后的影响[J]. 中华移植杂志(电子版), 2023, 17(02): 98-103.
[10] 张修源, 吕军好, 陈大进. 2022年肾移植领域研究进展[J]. 中华移植杂志(电子版), 2023, 17(01): 32-35.
[11] 朱晨晨, 韩飞, 寿张飞. HCV阳性供肾移植单中心回顾性研究[J]. 中华移植杂志(电子版), 2023, 17(01): 47-53.
[12] 李娜, 王丹. 肾移植受者HCV感染研究进展[J]. 中华移植杂志(电子版), 2023, 17(01): 58-62.
[13] 中国医师协会器官移植医师分会, 中华医学会器官移植学分会, 中华医学会外科学分会移植学组, 中国医院协会器官获取与分配工作委员会. 中国心脏死亡捐献器官评估与应用专家共识(2022版)[J]. 中华移植杂志(电子版), 2022, 16(06): 321-328.
[14] 李娜, 丁小明, 丁晨光, 王丹. 索非布韦联合雷迪帕韦在肾移植HCV感染受者中的应用[J]. 中华移植杂志(电子版), 2022, 16(06): 359-364.
[15] 邱成, 戴帅, 张乐希, 刘洪涛. 初始血型抗体效价水平对ABO血型不相合活体肾移植受体肾功能及免疫功能的影响[J]. 中华临床医师杂志(电子版), 2022, 16(10): 1005-1011.
阅读次数
全文


摘要