BKV, CMV, and EBV Interactions and their Effect on Graft Function One Year Post-Renal Transplantation: Results from a Large Multi-Centre Study.
BKV, CMV, and EBV Interactions and their Effect on Graft Function One Year Post-Renal Transplantation: Results from a Large Multi-Centre Study.
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DOI：
10.1016/j.ebiom.2018.07.017
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发表时间：
2018-08
期刊：
影响因子：
11.1
通讯作者：
Babel N
中科院分区：
文献类型：
--
作者：
Blazquez-Navarro A;Dang-Heine C;Wittenbrink N;Bauer C;Wolk K;Sabat R;Westhoff TH;Sawitzki B;Reinke P;Thomusch O;Hugo C;Or-Guil M;Babel N
BK病毒（BKV）、巨细胞病毒（CMV）和EB病毒（EBV）的再激活在肾移植后很常见，并与发病率和死亡率增加相关。虽然CMV可能是BKV和EBV的危险因素，但联合再激活的影响仍不清楚。本研究的目的是确定这些再活化的相互作用和对移植物功能的影响。通过qPCR分析了来自540名肾移植受者的3715份血清样本的病毒载量。在移植后第一年的8次访视中进行测量。平行收集临床特征，包括移植物功能（GFR）。BKV的流行率和病毒载量最高。BKV或CMV病毒载量超过10，000拷贝·mL−1会导致显著的GFR损害。57例患者发生BKV-CMV联合再激活，两种再激活显著相关（p = 0.005）。在相对较低的阈值（BKV > 1000和CMV > 4000拷贝·mL-1）下，联合再激活与移植后1年GFR显著降低11.7 mL·min-1·1.73 m-2（p = 0.02）相关。对于EB病毒，发现与巨细胞病毒再激活显着相关（p = 0.02），但没有发现肾小球滤过率降低。长时间冷缺血是高巨细胞病毒负荷的进一步风险因素。BKV-CMV联合再激活对移植后一年的肾功能有深刻的影响，因此最有可能对长期移植物功能产生影响，即使在低病毒载量下。建议对低BKV和/或CMV病毒血症水平和/或长冷缺血时间进行频繁的病毒监测和后续干预。研究者发起的试验;由德国联邦教育和研究部（BMBF）提供资金支持。
BK virus (BKV), Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivations are common after kidney transplantation and associated with increased morbidity and mortality. Although CMV might be a risk factor for BKV and EBV, the effects of combined reactivations remain unknown. The purpose of this study is to ascertain the interaction and effects on graft function of these reactivations. 3715 serum samples from 540 kidney transplant recipients were analysed for viral load by qPCR. Measurements were performed throughout eight visits during the first post-transplantation year. Clinical characteristics, including graft function (GFR), were collected in parallel. BKV had the highest prevalence and viral loads. BKV or CMV viral loads over 10,000 copies·mL−1 led to significant GFR impairment. 57 patients had BKV-CMV combined reactivation, both reactivations were significantly associated (p = 0.005). Combined reactivation was associated with a significant GFR reduction one year post-transplantation of 11.7 mL·min−1·1.73 m−2 (p = 0.02) at relatively low thresholds (BKV > 1000 and CMV > 4000 copies·mL−1). For EBV, a significant association was found with CMV reactivation (p = 0.02), but no GFR reduction was found. Long cold ischaemia times were a further risk factor for high CMV load. BKV-CMV combined reactivation has a deep impact on renal function one year post-transplantation and therefore most likely on long-term allograft function, even at low viral loads. Frequent viral monitoring and subsequent interventions for low BKV and/or CMV viraemia levels and/or long cold ischaemia time are recommended. Investigator Initiated Trial; financial support by German Federal Ministry of Education and Research (BMBF).
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