The related risk factors of BK virus activation in renal transplant recipients after transplantation: a meta-analysis

doi:10.3877/cma.j.issn.1674-3903.2020.03.012

Abstract

Abstract:

Objective

To provide a meta-analysis of the risk factors of BKV activation after kidney transplantation basing on the related published reports and to provide reference for the prevention and treatment of BKV nephropathy.

Methods

The published papers related to BKV activation after kidney transplantation in the PubMed database, the Chinese journal full-text database, the Wanfang database, and the Chinese biomedical database from the establishment of the database to the July 2019 were systematically searched, and the references of the papers were manually searched for supplemental papers. The quality of each study was evaluated using the Newcastle-Ottawa scale. The data of the risk factors were extracted and meta-analysed by RevMan 5.3 statistical software.

Results

A total of 22 studies were included, 15 of which were English literatures and 7 were Chinese literatures. The results showed that the risk factors of BKV detected in the blood were rejection (OR=1.91, 95%CI: 1.30-2.80), delayed graft function (OR=1.51, 95%CI: 0.99-2.31), taking tacrolimus (OR=1.50, 95%CI: 1.22-1.84), using antithymocyte globulin(ATG) induction (OR: 1.75, 95%CI: 1.02-2.98), using ureteral stent (OR=1.98, 95%CI: 1.19-3.30) and those with CMV infection (OR=2.23, 95%CI: 1.61-3.09); the risk factor of BKV detected in the urine was continuous use of glucocorticoid (OR=1.49, 95%CI: 1.09-2.04).

Conclusions

Kidney transplant recipients taking tacrolimus, co-infection with CMV, using ureteral stent, and using ATG after kidney transplantation have a higher risk of BK viremia, and kidney transplant patients who have taken hormones for a long time have a higher risk of BK viruria.

Key words: Kidney transplantation, BK virus, Risk factors, Meta-analysis

Tao Zhang, Xin Zhou, Yanfeng Wang, Zhengbin Hu, Rui Luo, Qifa Ye. The related risk factors of BK virus activation in renal transplant recipients after transplantation: a meta-analysis[J]. Chinese Journal of Transplantation(Electronic Edition), 2020, 14(03): 188-192.

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References 29

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作者及发表年限	国家	总例数	BKV血症(例)	BKV尿症(例)	危险因素	NOS评分
Borni-Duval 2013^[5]	法国	240	60	116	1，2，3，4，7，9	9
Dadhania 2008^[6]	美国	100	－	37	3，5，6，11	8
Huang 2014^[7]	中国	225	39	98	2，3，4，7	8
Masutani 2013^[8]	美国	998	102	－	2，6，9	9
Moura 2017^[9]	巴西	553	41	－	9，10	8
Radtke 2016^[10]	德国	348	44	－	1，2，4，12	8
Saundh 2013^[11]	英国	112	37	－	2，3，8	8
Schachtner 2015^[12]	德国	701	103	－	1，2，3，4，5，10，12	9
Shenagari 2017^[13]	伊朗	110	22	54	2，4，5，10	7
Siparsky 2011^[14]	美国	186	32	－	11	7
Steubl 2012^[15]	德国	128	57	－	4，5，10	7
Theodoropoulos 2013^[16]	美国	662	80	250	1，2，3，5，12	9
Vu 2014^[17]	美国	251	71	－	2，3，4，6	8
Wingate 2017^[18]	美国	403	89	－	11	8
Wunderink 2017^[19]	荷兰	407	111	－	1，4，8	8
龙建华2018^[20]	中国	280	－	70	2，3，4，10	7
张磊2009^[21]	中国	121	30	－	4，5，6	7
屠国伟2009^[22]	中国	90	9	22	2，4	7
陆明2007^[23]	中国	59	9	19	2，4，9，12	6
刘路鹏2009^[24]	中国	104	6	16	2，3，4	7
费爽2017^[25]	中国	149	18	55	2，3，4，7，9	7
李平2017^[26]	中国	448	－	89	2，3，4	8

作者及发表年限	国家	总例数	BKV血症(例)	BKV尿症(例)	危险因素	NOS评分
Borni-Duval 2013^[5]	法国	240	60	116	1，2，3，4，7，9	9
Dadhania 2008^[6]	美国	100	－	37	3，5，6，11	8
Huang 2014^[7]	中国	225	39	98	2，3，4，7	8
Masutani 2013^[8]	美国	998	102	－	2，6，9	9
Moura 2017^[9]	巴西	553	41	－	9，10	8
Radtke 2016^[10]	德国	348	44	－	1，2，4，12	8
Saundh 2013^[11]	英国	112	37	－	2，3，8	8
Schachtner 2015^[12]	德国	701	103	－	1，2，3，4，5，10，12	9
Shenagari 2017^[13]	伊朗	110	22	54	2，4，5，10	7
Siparsky 2011^[14]	美国	186	32	－	11	7
Steubl 2012^[15]	德国	128	57	－	4，5，10	7
Theodoropoulos 2013^[16]	美国	662	80	250	1，2，3，5，12	9
Vu 2014^[17]	美国	251	71	－	2，3，4，6	8
Wingate 2017^[18]	美国	403	89	－	11	8
Wunderink 2017^[19]	荷兰	407	111	－	1，4，8	8
龙建华2018^[20]	中国	280	－	70	2，3，4，10	7
张磊2009^[21]	中国	121	30	－	4，5，6	7
屠国伟2009^[22]	中国	90	9	22	2，4	7
陆明2007^[23]	中国	59	9	19	2，4，9，12	6
刘路鹏2009^[24]	中国	104	6	16	2，3，4	7
费爽2017^[25]	中国	149	18	55	2，3，4，7，9	7
李平2017^[26]	中国	448	－	89	2，3，4	8

危险因素	病毒检出部位	文章数量(篇)	BKV阳性例数/总例数		异质性检验		OR	95%CI	P值
危险因素	病毒检出部位	文章数量(篇)	暴露组	非暴露组	P值	I²(%)	OR	95%CI	P值
再次移植	血液	5	70/381	328/1 977	>0.1	25	1.16	0.87～ 1.56	0.320
?	尿液	2	84/176	282/726	≤0.1	84	1.51	0.62～ 3.65	0.360
排斥反应	血液	13	232/1 067	367/2 966	≤0.1	63	1.91	1.30～ 2.80	0.001
?	尿液	10	173/389	617/1 973	≤0.1	70	1.46	0.85～ 2.50	0.170
移植肾功能延迟恢复	血液	8	95/416	318/2 019	≤0.1	45	1.51	0.99～ 2.31	0.006
?	尿液	8	79/225	653/1 895	>0.1	8	0.96	0.71～ 1.30	0.780
他克莫司vs环孢素	血液	14	413/2 045	201/1 382	>0.1	9	1.50	1.22～ 1.84	<0.000
?	尿液	9	349/1 077	183/568	≤0.1	59	1.46	0.93～ 2.29	0.100
糖皮质激素	血液	5	208/1 106	84/616	>0.1	22	1.26	0.86～ 1.84	0.230
?	尿液	3	141/306	182/526	>0.1	56	1.49	1.09～ 2.04	0.010
ATG vs无免疫诱导	血液	2	36/113	40/175	≤0.1	66	1.75	1.02～ 2.98	0.040
ATG vs巴利昔单抗	血液	3	74/319	49/299	>0.1	0	1.04	0.64～ 1.69	0.860
?	尿液	3	154/320	115/299	>0.1	0	1.32	0.89～ 1.96	0.160
阿伦单抗vs巴利昔单抗	血液	2	108/438	15/81	>0.1	0	0.79	0.39～ 1.58	0.500
群体反应性抗体	血液	6	68/412	265/2 275	>0.1	0	1.35	0.99～ 1.84	0.060
?	尿液	3	68/156	122/294	>0.1	27	1.12	0.75～ 1.68	0.590
吗替麦考酚酯	血液	4	204/1 162	19/330	≤0.1	87	2.24	0.48～10.41	0.300
?	尿液	2	119/372	5/18	>0.1	0	1.23	0.42～ 3.60	0.710
输尿管支架	血液	2	100/428	21/161	>0.1	18	1.98	1.19～ 3.30	0.009
CMV	血液	4	78/362	158/1 400	>0.1	42	2.23	1.61～ 3.09	<0.000
?	尿液	2	32/70	237/643	>0.1	0	1.44	0.88～ 2.37	0.150

危险因素	病毒检出部位	文章数量(篇)	BKV阳性例数/总例数		异质性检验		OR	95%CI	P值
危险因素	病毒检出部位	文章数量(篇)	暴露组	非暴露组	P值	I²(%)	OR	95%CI	P值
再次移植	血液	5	70/381	328/1 977	>0.1	25	1.16	0.87～ 1.56	0.320
?	尿液	2	84/176	282/726	≤0.1	84	1.51	0.62～ 3.65	0.360
排斥反应	血液	13	232/1 067	367/2 966	≤0.1	63	1.91	1.30～ 2.80	0.001
?	尿液	10	173/389	617/1 973	≤0.1	70	1.46	0.85～ 2.50	0.170
移植肾功能延迟恢复	血液	8	95/416	318/2 019	≤0.1	45	1.51	0.99～ 2.31	0.006
?	尿液	8	79/225	653/1 895	>0.1	8	0.96	0.71～ 1.30	0.780
他克莫司vs环孢素	血液	14	413/2 045	201/1 382	>0.1	9	1.50	1.22～ 1.84	<0.000
?	尿液	9	349/1 077	183/568	≤0.1	59	1.46	0.93～ 2.29	0.100
糖皮质激素	血液	5	208/1 106	84/616	>0.1	22	1.26	0.86～ 1.84	0.230
?	尿液	3	141/306	182/526	>0.1	56	1.49	1.09～ 2.04	0.010
ATG vs无免疫诱导	血液	2	36/113	40/175	≤0.1	66	1.75	1.02～ 2.98	0.040
ATG vs巴利昔单抗	血液	3	74/319	49/299	>0.1	0	1.04	0.64～ 1.69	0.860
?	尿液	3	154/320	115/299	>0.1	0	1.32	0.89～ 1.96	0.160
阿伦单抗vs巴利昔单抗	血液	2	108/438	15/81	>0.1	0	0.79	0.39～ 1.58	0.500
群体反应性抗体	血液	6	68/412	265/2 275	>0.1	0	1.35	0.99～ 1.84	0.060
?	尿液	3	68/156	122/294	>0.1	27	1.12	0.75～ 1.68	0.590
吗替麦考酚酯	血液	4	204/1 162	19/330	≤0.1	87	2.24	0.48～10.41	0.300
?	尿液	2	119/372	5/18	>0.1	0	1.23	0.42～ 3.60	0.710
输尿管支架	血液	2	100/428	21/161	>0.1	18	1.98	1.19～ 3.30	0.009
CMV	血液	4	78/362	158/1 400	>0.1	42	2.23	1.61～ 3.09	<0.000
?	尿液	2	32/70	237/643	>0.1	0	1.44	0.88～ 2.37	0.150

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