A single-center retrospective analysis of the occurrence and outcome of BK virus infection after renal transplantation

doi:10.3877/cma.j.issn.1674-3903.2021.02.004

Abstract

Abstract:

Objective

To summarize the incidence, treatment and prognosis of BK virus (BKV) infection in renal transplant recipients.

Methods

The clinical data of recipients who underwent renal transplantation in the First Hospital of Jilin University from December 2015 to December 2018 and were regularly followed up and monitored for BKV infection were retrospectively analyzed to observe the incidence of each stage of BKV infection and the therapeutic effect and outcome.

Results

As of June 2019, the median follow-up time of 629 renal transplant recipients was 16 months. The incidence of BK viruria was 24.5% (154/629), and the detection time was (5.3±5.0) months after surgery; the incidence of BK viremia was 7.5% (47/629), and the detection time was (8.2±7.4) months after surgery; the incidence of BK virus nephropathy (BKVN) was 4.3% (27/629), the detection time was (14.5±8.4) months after surgery, and the incidence of renal allograft failure was 1.9% (12/629). The incidence of BKV infection is high within 12 months after renal transplantation. Among the 154 recipients with BK viruria after renal transplantation, 30 recipients with low-level BK viruria were treated with a close follow-up monitoring regimen, and 124 recipients with high-level BKV urination were treated with a rapid dose reduction regimen of immunosuppressive agents; 35.7% (55/154) had a decrease in urine BKV DNA load to a low level, 23.4% (36/154) had a negative urine BKV, 24.7% (38/154) had a persistently high urine BKV DNA load, 8.4% (13/154) progressed to BK viremia, 7.8% (12/154) progressed to BKVN, and no renal allograft failure occurred. Among the 47 recipients with BK viremia after renal transplantation, 44 were treated with immunosuppressant conversion regimen and 3 with immunosuppressant rapid dose reduction regimen; 55.3% (26/47) had negative serum BKV, 31.9% (15/47) progressed to BKVN, and 12.8% (6/47) had persistently positive serum BKV. All 27 BKVN recipients after renal transplantation were treated with immunosuppressant conversion+ antiviral treatment therapy; 63.0% (17/27) had negative serum BKV, 22.2% (6/27) had persistently positive serum BKV, all had abnormal renal allograft function, and 14.8% (4/27) had renal allograft failure.

Conclusions

The incidence of BKV infection is high at 1-year after renal transplantation. Regular screening of BKV during this period is of great significance for early detection of infection and preemptive treatment.

Key words: BK virus, Renal transplantation, BK viremia, BK viruria, BK virus nephropathy

Dechuan Liu, Honglan Zhou, Gang Wang, Junyan Liu, Yaxiang Zhu, Di Yu, Jinguo Wang. A single-center retrospective analysis of the occurrence and outcome of BK virus infection after renal transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2021, 15(02): 81-85.

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URL: https://zhyzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3903.2021.02.004

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References 22

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治疗方案及转归		BKV尿症(n＝154)	BKV血症(n＝47)	BKVN(n＝27)
治疗方案
	严密随访	30	-	-
	免疫抑制剂快速减量	124	3	-
	免疫抑制剂转换	-	44	-
	免疫抑制剂转换+抗病毒治疗	-	-	27
治疗效果
	尿液BKV转阴	36	3	3
	尿液BKV DNA载量<1×10⁷ copies/mL	55	14	9
	尿液BKV DNA载量≥1×10⁷ copies/mL	38	9	5
	血清BKV转阴	-	26	17
	血清BKV持续阳性	-	6	6
	进展为BKV血症	13	-	-
	进展为BKVN	12	15	-
	移植肾失功	0	0	4
排斥反应		8	9	5

治疗方案及转归		BKV尿症(n＝154)	BKV血症(n＝47)	BKVN(n＝27)
治疗方案
	严密随访	30	-	-
	免疫抑制剂快速减量	124	3	-
	免疫抑制剂转换	-	44	-
	免疫抑制剂转换+抗病毒治疗	-	-	27
治疗效果
	尿液BKV转阴	36	3	3
	尿液BKV DNA载量<1×10⁷ copies/mL	55	14	9
	尿液BKV DNA载量≥1×10⁷ copies/mL	38	9	5
	血清BKV转阴	-	26	17
	血清BKV持续阳性	-	6	6
	进展为BKV血症	13	-	-
	进展为BKVN	12	15	-
	移植肾失功	0	0	4
排斥反应		8	9	5

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