Reactivation of BK Virus in the Early Period After Kidney Transplantation
Reactivation of BK Virus in the Early Period After Kidney Transplantation
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DOI：
10.1016/j.transproceed.2009.01.036
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发表时间：
2009-03-01
影响因子：
0.9
通讯作者：
Rozental, R.
中科院分区：
文献类型：
--
作者：
Ziedina, I.;Folkmane, I.;Rozental, R.
背景资料。通常，多瘤BK病毒(BKV)在初次感染后仍潜伏在泌尿生殖道中。肾移植受者BKV的重新激活可导致进行性移植物功能障碍，称为BK病毒肾病(BKVN)。BKVN治疗的基础是预防，因此，及早发现BKV重新激活，减少免疫抑制是重要的。我们试图在前瞻性研究中确定BKV复发率及其相关因素。材料和方法。我们研究了37例连续的未选择的成人受者，他们在2007年接受了已故供者肾移植，并完成了至少3个月的观察。采用巢式聚合酶链式反应定性检测尿液和血浆标本中的BKV DNA。在所有情况下。术后第1天或术后2周未发现BK病毒血症或病毒尿。3个月后，37例受者中有6例(16%)发生BKV再激活。5例同时出现病毒血症和病毒尿，仅1例出现病毒血症。BK病毒血症的显著危险因素是体重指数和GT；30 kg/m(2)(P=0.02)、再次移植(P=0.04)和使用曲莫司(P=0.02)。在活动性BKV感染的患者中，移植后3个月的血肌酸值显著升高(P=0.008)。早在移植后3个月，早期BKV重新激活与移植物功能较差有关。肥胖、再次移植和曲罗莫司的使用是促进BKV病毒血症早期发展的因素。
Background. Typically, polyoma BK virus (BKV) remains latent in the urogenital tract after primary infection. Reactivation of BKV in recipients of kidney allografts can cause progressive graft dysfunction known as BK virus nephropathy (BKVN). The cornerstone of treatment for BKVN is prevention; therefore, it is important to detect BKV reactivation early and reduce immunosuppression. We Sought to identify the BKV reactivation rate and associated factors in a prospective study.Materials and Methods. We studied 37 consecutive unselected adult recipients who underwent deceased donor kidney transplantation in 2007 and completed at least 3 months of observation. Qualitative nested polymerase chain reaction (PCR) testing was performed to detect BKV DNA in urine and plasma specimens.Results. In all cases. BK viremia or viruria was not detected on the postoperative day or 2 weeks thereafter. At 3 months, BKV reactivation developed in 6 (16%) of 37 recipients. Simultaneous viremia and viruria were present on 5 patients and viremia only in I patient. Significant risk factors for BK viremia were body mass index >30 kg/m(2) (P = .02), retransplantation (P = .04), and use of tracolimus (P = .02). Serum creatinine values at 3 months after transplantation were significantly higher among patients with active BKV infection (P = .008).Conclusions. Early BKV reactivation is associated with worse graft function as early as 3 months after transplantation. Obesity, retransplantation, and use of tracrolimus were factors promoting early development of BKV viremia.