| Objectives:1.To summarize the incidence of high-level of BK viruria after single-center kidney transplantation,analyze its risk factors and its significance in the prevention of BK virus associated nephropathy(BKVAN);2.To investigate the safety and effect of preemptive treatment for high-level of BK viruria after kidney transplantation to control the progression of BK virus infection.Methods:1.Retrospective analysis was performed on 262 recipients who had conducted kidney transplantation in Organ Transplantation Department of Jiangxi Provincial People’s Hospital from 2015/01/01 to 2018/12/31 and regular follow-up data were retained.According to the BK viral DNA load,the recipients were divided into high-level BK viruria group and non-high-level BK viruria group.To summarize the occurrence of high-level of BK viruria after renal transplantation.The risk factors of high-level of BK viruria after kidney transplantation were analyzed by univariate and multivariate methods.Kaplan-Meier was used to draw the survival curve for survival analysis.2.Retrospectively collected the clinical data of kidney transplant recipients who were diagnosed with BK Viruria in Organ Transplantation Department of Jiangxi Provincial People’s Hospital from 2016/01/01 to 2018/12/31 and were given prompt intervention.To analyze the changes that before the intervention and after the treatment of the 1/2/3/6/12 months in the blood and urine BKV DNA load and the changes in the serum creatinine/uric acid/complications before and after treatment in the 12 months.Results:1.Among the 262 renal transplant recipients,the incidence of high BK viruria was 13.4%(n=35)and the median duration of disease was 181(126,315)days.Theincidence was the highest within 6 months after renal transplantation,gradually decreased from 6 months to 2 years,and then increased after 2 years.Univariate analysis showed that the history of antithymocyte globulin(ATG)treatment,acute rejection(AR),donation type and delayed graft function(DGF)were the risk factors of high-level BK viruria after renal transplantation(all P<0.05).Multivariate Cox’s regression analysis demonstrated that donation after brain death followed by cardiac death(DBCD),AR and DGF were the independent risk factors of high-level BK viruria after renal transplantation.The 1-,3-and 5-year survival rates of recipients with ATG treatment history,AR,DGF and donation type of DBCD were significantly lower than those of without ATG treatment history,AR,DGF and donation after brain death(DBD),donation after cardiac death(DCD)and living organ donation respectively(all P<0.05).2.A total of 38 qualified cases were collected,of which 38(100%)were positive for urine BKV DNA,and 4(10.5%)were also positive for blood BKV DNA.After Treatment for 12 months,serum BKV DNA was negative in 38 patients(100%),and urine BKV DNA was negative in 32 patients(84.2%)with a median time of 1.5(1.0,3.0)months.6 patients(15.8%)were positive for urine BKV DNA.38 patients(100%)survived with functional kidney of transplantation,and none had acute rejection between the treatment periods of 12 months.Before the changes of the immunosuppression regimen,serum creatinine level of the 38 patients was 108±20.5μmol/L,and serum uric acid level was 328.7±78.5 μmol/L.After 12 months of treatment,serum creatinine was reviewed with 108.1±20.3 μmol/L,and serum uric acid level was 332.4±50.6 μmol/L.Conclusions:1.DBCD,AR and DGF are the independent risk factors of high-level BK viruria after renal transplantation.Strengthening the frequency of postoperative monitoring and delivering early intervention may effectively prevent BKVAN.2.The intervention scheme that the Mizoribine(MZR)replaced the Mycophen-olate Mofetil(MMF)after renal transplantation into the high-level BK viruria can safely control the progression of BK virus infection and that may have important implications for the prevention of BKVAN. |
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