CMV Viremia Is Associated With a Decreased Incidence of BKV Reactivation after Kidney and Kidney-Pancreas Transplantation
CMV Viremia Is Associated With a Decreased Incidence of BKV Reactivation after Kidney and Kidney-Pancreas Transplantation
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DOI：
10.1097/tp.0b013e3182a6890d
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发表时间：
2013-12-27
期刊：
影响因子：
6.2
通讯作者：
Mossad, Sherif B.
中科院分区：
文献类型：
--
作者：
Elfadawy, Nissreen;Flechner, Stuart M.;Mossad, Sherif B.
背景。巨细胞病毒（CMV）和BK病毒（BKV）感染可在肾脏和肾胰移植后引起显著的发病率。关于这两种病毒病原体的流行病学和相互作用的资料有限。我们从2007年1月至2011年6月对609例肾或肾胰移植受者进行了BKV和/或CMV病毒血症的前瞻性筛查。其中包括7453例定量BKV聚合酶链反应和15496例定量CMV聚合酶链反应。我们评估了这些感染的危险因素和时机，以及一种感染的治疗对另一种感染的影响。609例受者中，108例（17.7%）发生巨细胞病毒血症，其中95例（88%）无症状，5例（5%）有巨细胞病毒综合征，8例（7%）在移植后5.6个月发生巨细胞病毒组织侵袭性疾病。多变量分析CMV感染的危险因素为D+R-血清组(1)50岁（P=0.013），他克莫司（P=0.0009）和霉酚酸酯（P=0.01）平均血药浓度较高。BKV感染在总人口中的发生率为163 / 609(26.7%)，其中150例（92%）发生在没有CMV病毒血症的患者中。这些患者的后续BKV病毒血症发生率高于先前有CMV病毒血症的患者（P=0.003；风险比为2,05；9515可信区间为1.2-3.4）。此外，我们发现，与无症状和无CMV病毒血症相比，只有有症状的CMV病毒血症对移植物存活有显著的负面影响（相对危险度为3.5；95%可信区间为1.06-8.9；P=0.04）。巨细胞病毒血症可能间接预防随后的BK病毒血症，这可能是由于巨细胞病毒血症诊断后免疫抑制强度的降低。
Background. Cytomegalovirus (CMV) and BK virus (BKV) infections can cause significant morbidity after kidney and kidney-pancreas transplant. There are limited data on the epidemiology and interactions between these two viral pathogens.Methods. We prospectively screened 609 kidney or kidney-pancreas transplant recipients from January 2007 to June 2011 for BKV and/or CMV viremia. This included 7453 quantitative BKV polymerase chain reaction and 15,496 quantitative CMV polymerase chain reaction tests. We evaluated risk factors and timing of these infections and the impact of treatment of one infection on the other.Results. Among 609 recipients, 108 (17.7%) developed CMV viremia, of which 95 (88%) were asymptomatic, 5 (5%) had CMV syndrome, and 8 (7%) developed CMV tissue invasive disease at a median of 5.6 months after transplantation. Risk factors for CMV infection using multivariable analysis were D+R- serogroup (1)50 years (P=0.013), and higher mean tacrolimus (P=0.0009) and mycophenolate mofetil (P=0.01) blood levels. The incidence of BKV infection in the total population was 163 of 609 (26.7%), of which 150 (92%) occurred in patents without antecedent CMV viremia. Such patients demonstrated a higher rate of subsequent BKV viremia than patients with antecedent CMV viremia (P=0.003; hazard ratio, 2,05; 9515 confidence interval, 1.2-3.4). Moreover, we found that only symptomatic CMV viremia had a significant negative impact on graft survival when compared with asymptomatic CMV viremia and those without CMV viremia (relative risk, 3.5; 95% confidence interval, 1.06-8.9; P=0.04).Conclusion. CMV viremia may indirectly protect against subsequent BK viremia possibly due to a reduction of intensity of immunosuppression after diagnosis of CMV vircmia.