Association of BK Virus Titers With Lymphocyte Count in Renal Transplant Patients
Association of BK Virus Titers With Lymphocyte Count in Renal Transplant Patients
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DOI：
10.1016/j.transproceed.2015.04.042
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发表时间：
2015-06-01
影响因子：
0.9
通讯作者：
Ozener, C.
中科院分区：
文献类型：
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作者：
Velioglu, A.;Aksu, B.;Ozener, C.
目标.建议定期筛查BK病毒（BKV），以便对肾移植患者进行早期干预。确定BK病毒血症发展的预测因子将改善其监测。我们进行了一项回顾性研究，调查淋巴细胞计数是否可能是肾移植患者BKV发展的预测因子。我们回顾性分析了2011年1月至2014年8月在我们诊所随访的268例肾移植患者。根据相关指导原则，采用实时定量聚合酶链反应检测血液中BKV病毒载量。我们还回顾性监测了淋巴细胞计数、肌酐、免疫抑制药物剂量和他克莫司/环孢素/mTor抑制剂水平。从患者档案中提取人口统计学和其他临床数据。计算相关系数并进行受试者工作特征（ROC）曲线分析。总体而言，16例（5.9%）发生BKV-DNA阳性的患者入选研究。患者的平均年龄为38.2 ± 12.8岁。所有患者均接受类固醇和钙调磷酸酶抑制剂（CNIs）。霉酚酸酯/霉酚酸（MMF/MPA）治疗14例。BKV-DNA阳性率为72.7%（64/88）。BKV-DNA检测阳性患者第一天的淋巴细胞计数显著低于BKV-DNA检测阴性患者（分别为1700/mu l vs 2400/mu l; P = 0.009）。其ROC曲线的AUC为0.77（P = 0.012）。淋巴细胞计数的最佳临界值为1900/μ l，预测BKV阳性的敏感性和特异性分别为75%和78.57%。我们还发现淋巴细胞计数与首次检测到的BKV滴度呈负相关（r =-0.438; P =.015）。然而，CNI/mTOR抑制剂水平、MMF/MPA剂量、淋巴细胞计数和所有BKV滴度之间无相关性。淋巴细胞计数减少可能是先前BKV病毒血症的预测因子。临床医生应更加小心肾移植患者中BKV复制时淋巴细胞计数的减少。
Objectives. Regular screening for the BK virus (BKV) is recommended for early intervention in renal transplant patients. Identification of predictors for the development of BK viremia would improve their monitoring. We performed a retrospective study investigating whether the lymphocyte count may be a predictor of BKV development in renal transplant patients.Patients and Methods. We retrospectively analyzed 268 renal transplant patients who were followed in our clinic from January 2011 to August 2014. The viral loads of BKV in blood detected by quantitative real-time polymerase chain reaction test were performed according to relevant guidelines. We also retrospectively monitored lymphocyte count, creatinine, immunosuppressive drug doses, and tacrolimus/cyclosporine/mTor inhibitors levels during the same time as BKV screening. Demographic and other clinical data were extracted from patients' files. The calculation of correlation coefficients and receiver operating characteristics (ROC) curve analysis were performed.Results. Overall, 16 patients (5.9%) who experienced BKV-DNA positivity were included the study. Mean age of patients was 38.2 +/- 12.8 years. All patients received steroid and calcineurin inhibitors (CNIs). Mycophenolate mofetil/mycophenolic acid (MMF/MPA) was administered to 14 patients. BKV-DNA was found in 64 of the 88 (72.7%) plasma samples. The lymphocyte count on the first day of positive BKV-DNA test was significantly lower than in those with negative BKV-DNA results (1700/mu l vs 2400/mu l, respectively; P = .009). Its AUC of the ROC curve was 0.77 (P = .012). The optimal cutoff point for lymphocyte count was 1900/mu l, and sensitivity and specificity for predict BKV positivity were 75% and 78.57%, respectively. We also found that lymphocyte count negatively correlated with the first detectable BKV titers (r = -0.438; P = .015). However, there is no relation between CNI/mTOR inhibitor levels, MMF/MPA doses, lymphocyte count, and all BKV-titers.Conclusions. Decreased lymphocyte count may be a predictor for preceding BKV viremia. Clinicians should be more careful in terms of the decreased lymphocyte count in case of BKV replication in renal transplant patients.