熊睿, 丁利民, 杨华, 等. 肾移植术后高水平BK病毒尿症危险因素分析[J]. 器官移植, 2021, 12(3): 317-323. DOI: 10.3969/j.issn.1674-7445.2021.03.010
引用本文: 熊睿, 丁利民, 杨华, 等. 肾移植术后高水平BK病毒尿症危险因素分析[J]. 器官移植, 2021, 12(3): 317-323. DOI: 10.3969/j.issn.1674-7445.2021.03.010
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Xiong Rui, Ding Limin, Yang Hua, et al. Analysis of risk factors of high-level BK viruria after renal transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 317-323. DOI: 10.3969/j.issn.1674-7445.2021.03.010
Citation: Xiong Rui, Ding Limin, Yang Hua, et al. Analysis of risk factors of high-level BK viruria after renal transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 317-323. DOI: 10.3969/j.issn.1674-7445.2021.03.010
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肾移植术后高水平BK病毒尿症危险因素分析

Analysis of risk factors of high-level BK viruria after renal transplantation

    摘要
  • 摘要:
      目的  分析肾移植术后高水平BK病毒尿症的危险因素及其对预防BK病毒相关性肾病（BKVAN）的意义。
      方法  回顾性分析262例保留规律随访资料的肾移植受者的临床资料。根据受者BK病毒DNA载量分为高水平BK病毒尿症组（35例）和非高水平BK病毒尿症组（227例）。总结肾移植术后高水平BK病毒尿症的发生情况；采用单因素和多因素分析肾移植术后发生高水平BK病毒尿症的危险因素；采用Kaplan-Meier法绘制生存曲线，对受者进行生存分析。
      结果  262例肾移植受者中，35例发生高水平BK病毒尿症，发生率为13.4%。发生中位时间181（126，315）d，发生率在移植术后6个月内最高，6个月至2年逐渐降低，2年后有所回升。单因素分析结果提示抗胸腺细胞球蛋白（ATG）治疗史、急性排斥反应（AR）、捐献类型及移植物功能延迟恢复（DGF）是肾移植术后发生高水平BK病毒尿症的危险因素（均为P < 0.05）。多因素Cox回归分析结果显示脑-心双死亡器官捐献（DBCD）、AR及DGF是肾移植术后发生高水平BK病毒尿症的独立危险因素。有ATG治疗史、发生AR、发生DGF以及捐献类型为DBCD的受者的1、3、5年生存率分别低于无ATG治疗史、无发生AR、无发生DGF及其他捐献类型脑死亡器官捐献（DBD）、心脏死亡器官捐献（DCD）和活体器官捐献的受者（均为P < 0.05）。
      结论  DBCD、AR及DGF是肾移植术后发生高水平BK病毒尿症的独立危险因素，加强对此类受者的术后监测并给予早期干预可能是预防BKVAN的有效方式。

     

    Abstract:
      Objective  To analyze the risk factors of high-level BK viruria after renal transplantation and the significance in preventing BK virus-associated nephropathy (BKVAN).
      Methods  Clinical data of 262 renal transplant recipients with regular follow-up data were retrospectively analyzed. According to the DNA load of BK virus, all recipients were divided into the high-level BK viruria group (n=35) and non-high-level BK viruria group (n=227). The incidence of high-level BK viruria after renal transplantation was summarized. The risk factors of high-level BK viruria after renal transplantation were analyzed by univariate analysis and multivariate analysis. Survival curve was delineated by Kaplan-Meier method, and survival analysis of recipients was performed.
      Results  Among 262 renal transplant recipients, 35 cases developed high-level BK viruria with an incidence of 13.4%. The median time of occurrence of high-level BK viruria was 181 (126, 315) d. The incidence 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 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 with non-ATG treatment history, non-AR, non-DGF and other donation types donation after brain death (DBD), donation after cardiac death (DCD) and living organ donation respectively (all P < 0.05).
      Conclusions  DBCD, AR and DGF are the independent risk factors of high-level BK viruria after renal transplantation. Strengthening the postoperative monitoring of these recipients and delivering early intervention may effectively prevent BKVAN.

     

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