Factors Influencing Graft Outcomes Following Diagnosis of Polyomavirus -Associated Nephropathy after Renal Transplantation.
Factors Influencing Graft Outcomes Following Diagnosis of Polyomavirus -Associated Nephropathy after Renal Transplantation.
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多瘤病毒诊断后影响移植结果的因素 - 肾移植后相关肾病
DOI：
10.1371/journal.pone.0142460
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Chen LZ
中科院分区：
文献类型：
--
作者：
Huang G;Wu LW;Yang SC;Fei JG;Deng SX;Li J;Chen GD;Fu Q;Deng RH;Qiu J;Wang CX;Chen LZ
多瘤病毒相关性肾病（PVAN）是早期移植物丢失的重要原因，其病程难以预测。本研究的目的是确定影响PVAN结果的因素。在2006年至2014年期间，我们在修改维持免疫抑制后每1-4周监测一次BK病毒的615名患者中诊断出48名（7.8%）PVAN。进行Logistic或考克斯回归分析以确定哪些风险因素分别独立影响临床结局和移植物丢失。随访32.1±26.4个月后，诊断后1年时任何移植物功能下降、移植物丢失和末次随访时任何移植物功能下降的频率分别为27.1%（13/48）、25.0%（12/48）和33.3%（16/48）。术后1、3、5年移植肾存活率分别为100%、80.5%和69.1%。C级患者诊断后1年的平均血肌酐水平和移植肾长期存活率最差（p<0.05）。46例BKV DNA尿患者中有38例（82.6%）病毒载量降低90%，中位时间为2.75个月（范围0.25-34.0个月），移植物存活率高于8例病毒载量未降低的患者（17.4%）（p<0.001）。多变量logistic回归分析显示，广泛的间质性炎症（OR 20.2，p = 0.042）和尿液中尿液病毒载量的延迟下降（>2.75个月，下降>90%）（OR 16.7，p = 0.055）与诊断后1年的肌酐恶化相关。多变量考克斯回归分析显示，诊断时广泛的间质炎症（HR 46988，p = 0.032）和高PVAN分期（HR 162.2，p = 0.021）与移植物长期存活率较差相关。间质性炎症的程度影响PVAN患者的短期和长期移植结局。PVAN的程度、病毒载量的降低率和病毒清除率也可用作PVAN的预后标志。
Polyomavirus associated nephropathy (PVAN) is a significant cause of early allograft loss and the course is difficult to predict. The aim of this study is to identify factors influencing outcome for PVAN. Between 2006 and 2014, we diagnosed PVAN in 48 (7.8%) of 615 patients monitored for BK virus every 1–4 weeks after modification of maintenance immunosuppression. Logistic or Cox regression analysis were performed to determine which risk factors independently affected clinical outcome and graft loss respectively. After 32.1±26.4 months follow-up, the frequencies of any graft functional decline at 1 year post-diagnosis, graft loss and any graft functional decline at the last available follow-up were 27.1% (13/48), 25.0% (12/48), and 33.3% (16/48), respectively. The 1, 3, 5 year graft survival rates were 100%, 80.5% and 69.1%, respectively. The mean level of serum creatinine at 1 year post-diagnosis and long-term graft survival rates were the worst in class C (p<0.05). Thirty-eight of 46 (82.6%) BKV DNAuria patients reduced viral load by 90% with a median time of 2.75 months (range, 0.25–34.0 months) and showed better graft survival rates than the 8 patients (17.4%) without viral load reduction (p<0.001). Multivariate logistic regression analysis showed that extensive interstitial inflammation (OR 20.2, p = 0.042) and delayed fall in urinary viral load (>2.75 months for >90% decrease) in urine (OR 16.7, p = 0.055) correlated with worse creatinine at 1 year post-diagnosis. Multivariate Cox regression analysis showed that extensive interstitial inflammation (HR 46988, p = 0.032) at diagnosis, and high PVAN stage (HR 162.2, p = 0.021) were associated with worse long-term graft survival rates. The extent of interstitial inflammation influences short and long-term graft outcomes in patients with PVAN. The degree of PVAN, rate of reduction in viral load, and viral clearance also can be used as prognostic markers in PVAN.