疫情常态化防控期间不规律随访对肾移植术后BK病毒再激活时的病毒载量及受者预后影响

Effect of irregular follow-up during normalized prevention and control of epidemic on viral load upon BK virus reactivation and prognosis of kidney transplant recipients

    摘要
  • 摘要:
      目的  探讨在新型冠状病毒肺炎疫情常态化防控期间不规律随访对肾移植受者术后BK病毒（BKV）再激活情况及预后的影响。
      方法  回顾性分析363例肾移植受者的临床资料，按随访时间分为疫情前随访组与疫情期间随访组，随访期限为1年。比较疫情前随访组和疫情期间随访组的随访时间间隔，分析两组BKV感染情况，分析BKV感染进程与移植肾功能的相关性。
      结果  疫情前随访共计1 790例次，疫情期间随访共计2 680例次。与疫情期间随访组比较，疫情前随访组术后3个月内、3~6个月、7~12个月的随访时间间隔较短，差异均有统计学意义（均为P<0.05）。在肾移植术后1年内，疫情前随访组35例（32%）检出BKV尿症、3例（3%）检出BKV血症、1例（1%）检出BKV相关肾病（BKVAN），疫情期间随访组53例（25%）检出BKV尿症、3例（1%）检出BKV血症、1例（1%）检出BKVAN，差异均无统计学意义（均为P>0.05）。疫情前随访组术后首次检出BKV尿症时间长于疫情期间随访组，首次再激活尿BKV载量小于疫情期间随访组，差异均有统计学意义（均为P<0.05）。首次再激活尿BKV载量与尿BKV载量峰值，BKV再激活后第1、3个月血清肌酐与基线血清肌酐差值呈正相关（均为P<0.05）。
      结论  肾移植术后不规律随访可导致BKV再激活时间提前、首次尿BKV载量检出值更高，以及延迟诊断和干预，并造成不良预后。亟待建立远程随访体系以满足发生公共卫生事件时肾移植受者的随访需求。

     

    Abstract:
      Objective  To evaluate the effect of irregular follow-up during normalized prevention and control of novel coronavirus pneumonia (COVID-19) epidemic on BK virus (BKV) reactivation and clinical prognosis of kidney transplant recipients.
      Methods  Clinical data of 363 kidney transplant recipients were retrospectively analyzed, and they were divided into the pre-epidemic follow-up group and during-epidemic follow-up group according to the follow-up time. All patients were followed up for 1 year. The follow-up interval was compared between two groups. The infection of BKV and the correlation between the infection process of BKV and renal graft function were analyzed in two groups.
      Results  A total of 1 790 preson-times were followed up before COVID-19 epidemic and 2 680 during COVID-19 epidemic. Compared with the during-epidemic follow-up group, the follow-up intervals within 3, 3-6 and 7-12 months after kidney transplantation were shorter in the pre-epidemic follow-up group, and the differences were statistically significant (all P<0.05). Within 1 year after kidney transplantation, 35 cases（32%） were diagnosed with BKV viruria, 3 cases（3%） of BKV viremia and 1 case（1%） of BKV-associated nephropathy (BKVAN) in the pre-epidemic follow-up group, and 53（25%）, 3（1%） and 1（1%） in the during-epidemic follow-up group, with no statistical significance (all P>0.05). In the pre-epidemic follow-up group, the time for the initial diagnosis of BKV viruria was longer and the viral load of the first urinary BKV reactivation was smaller than those in the during-epidemic follow-up group, with statistical significance (both P<0.05). The load of the first urinary BKV reactivation was positively correlated with the peak load of urinary BKV, and the differences between the baseline and serum creatinine levels at 1 and 3 months after BKV reactivation (all P<0.05).
      Conclusions  Irregular follow-up after kidney transplantation may lead to early BKV reactivation and higher detection value of the first viral load of urinary BKV, delay diagnosis and interventions, and lead to poor prognosis. It is urgent to establish a remote follow-up system to meet the follow-up requirements of kidney transplant recipients when public health incidents occur.

     

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