Early clearance of BK polyomavirus-DNAemia among kidney transplant recipients may lead to better graft survival.

IF 2.6 4区医学 Q3 IMMUNOLOGY Transplant Infectious Disease Pub Date : 2024-09-03 DOI:10.1111/tid.14371

Isabel Breyer, Lucy Ptak, David Stoy, Didier Mandelbrot, Sandesh Parajuli

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Abstract

Introduction: BK polyomavirus (BKPyV)-DNAemia is a common complication in kidney transplant recipients (KTRs). The significance of achieving viral clearance at different time intervals is not well understood.

Methods: All adult KTRs transplanted between January 1, 2015 and December 31, 2017 who developed BKPyV-DNAemia were included. Outcomes were analyzed based on persistent clearance of BKPyV-DNAemia at 3-month intervals up to 2 years after initial detection, and for recipients with persistent BKPyV-DNAemia at last follow-up. Uncensored graft failure, death-censored graft failure (DCGF), and a composite outcome of DCGF or fall in estimated glomerular filtration rate (eGFR) by ≥50% from the time of initial BKPyV-DNAemia were outcomes of interest.

Results: Of 224 KTRs with BKPyV-DNAemia, 58 recipients (26%) achieved viral clearance by 3 months after initial detection, 105 (47%) by 6 months, 120 (54%) by 9 months, 141 (63%) by 12 months, 155 (69%) by 15 months, 167 (75%) by 18 months, 180 (80%) by 21 months, and 193 (86%) by 24 months. Nine recipients (4%) had persistent BKPyV-DNAemia at last follow-up. Compared to recipients who achieved viral clearance by 3 months, those who achieved clearance by 6 months (adjusted odds ratio [aOR]: 3.15; 95% confidence interval [CI]: 1.22-8.12; p = .02) and 9 months (aOR: 3.69; 95% CI: 1.02-13.43; p = .04) had significantly increased risk for uncensored graft failure. There was no significant association between time to viral clearance and DCGF or composite outcomes.

Conclusions: We found a trend of increased risk for uncensored graft failure among those who cleared BKPyV-DNAemia more slowly. Aiming to clear viremia early, without risking rejection, may be beneficial for allograft function and patient morbidity and mortality.

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肾移植受者早期清除 BK 多瘤病毒-DNA 血症可提高移植物存活率。

导言：BK多瘤病毒（BKPyV）-DNA血症是肾移植受者（KTR）常见的并发症。在不同时间间隔实现病毒清除的意义尚不十分清楚：纳入所有在 2015 年 1 月 1 日至 2017 年 12 月 31 日期间接受移植并出现 BKPyV-DNAemia 的成年 KTR。根据初次检测到 BKPyV-DNAemia 后 2 年内每 3 个月持续清除 BKPyV-DNAemia 的情况，以及最后一次随访时持续存在 BKPyV-DNAemia 的受者的结果进行分析。结果显示，未剪切移植物失败、死亡剪切移植物失败（DCGF）以及DCGF或估计肾小球滤过率（eGFR）较最初发生BKPyV-DNA血症时下降≥50%的综合结果均为受试者关注的结果：在 224 例出现 BKPyV-DNAemia 的 KTR 中，58 例受者（26%）在初次检测后 3 个月内清除了病毒，105 例（47%）在 6 个月内清除了病毒，120 例（54%）在 9 个月内清除了病毒，141 例（63%）在 12 个月内清除了病毒，155 例（69%）在 15 个月内清除了病毒，167 例（75%）在 18 个月内清除了病毒，180 例（80%）在 21 个月内清除了病毒，193 例（86%）在 24 个月内清除了病毒。最后一次随访时，有 9 名受者（4%）出现持续的 BKPyV-DNA 血症。与 3 个月病毒清除的受者相比，6 个月病毒清除的受者（调整赔率比 [aOR]：3.15; 95% 置信区间 [CI]：1.22-8.12; p = .02）和 9 个月（aOR：3.69; 95% CI：1.02-13.43; p = .04）前实现病毒清除的受者发生未删减移植物失败的风险显著增加。病毒清除时间与 DCGF 或综合结果之间无明显关联：结论：我们发现，BKPyV-DNA血症清除速度较慢的患者发生未校正移植物失败的风险呈上升趋势。在不冒排斥风险的情况下尽早清除病毒血症，可能对异体移植功能、患者发病率和死亡率有益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.