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:
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人次，疫情期间随访共计2 680人次。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BKV尿症病毒载量与尿BKV载量峰值、BKV再激活后第1、3个月肌酐与基线肌酐差值相关（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、首次尿病毒载量检出值更高，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 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 viral load of the first urinary BKV reactivation was associated with the peak viral load of urinary BKV, and the differences between the baseline and 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. -
Key words:
- Kidney transplantation /
- BK virus /
- Follow-up /
- Novel coronavirus /
- Normalization of epidemic /
- BK viremia /
- BK viruria /
- BKV-associated nephropathy
-
图 1 首次再激活时尿BKV载量与移植肾功能的相关性分析
注：A图为尿BKV载量峰值与首次再激活尿BKV载量的相关性；B图为BKV再激活后第1个月肌酐与基线肌酐差值与首次再激活尿BKV载量的相关性；C图为BKV再激活后第3个月肌酐与基线肌酐差值与首次再激活尿BKV载量的相关性。
Figure 1. Correlation analysis between urinary BKV load at first reactivation and transplant kidney function
表 1 术后12个月内疫情前随访组与疫情期间随访组随访间隔的比较（$\overline {\boldsymbol{x}} $±s，d）
Table 1. Comparison of follow-up intervals between the pre epidemic follow-up group and the follow-up group during the epidemic period within 12 months after surgery
分组 例次 术后随访间隔 3个月内 3~6个月 7~12个月 疫情前随访组 1 790 10±5 23±9 30±12 疫情期间随访组 2 680 11±6 24±10 32±16 P值 0.010 0.028 0.048 
下载: 导出CSV
-
[1] KANT S, DASGUPTA A, BAGNASCO S, et al. BK virus nephropathy in kidney transplantation: a state-of-the-art review[J]. Viruses, 2022, 14(8): 1616. DOI: 10.3390/v14081616. [2] 周易, 姚雷雨, 于哲, 等. BK多瘤病毒在肾移植受者中的感染特征[J]. 南方医科大学学报, 2019, 39(1): 120-124. DOI: 10.12122/j.issn.1673-4254.2019.01.19.ZHOU Y, YAO LY, YU Z, et al. Characteristics of BK polymavirus infection in kidney transplant recipients[J]. J Southern Med Univ, 2019, 39(1): 120-124. DOI: 10.12122/j.issn.1673-4254.2019.01.19. [3] WANG Y, FANG Y, YAN Z, et al. Fatal BK polyomavirus-associated pneumonia: report of two cases with literature review[J]. BMC Infect Dis, 2023, 23(1): 592. DOI: 10.1186/s12879-023-08577-2. [4] PINTO M, DOBSON S. BK and JC virus: a review[J]. J Infect, 2014, 68(Suppl 1): S2-S8. DOI: 10.1016/j.jinf.2013.09.009. [5] LIU N, GU C, YANG Y, et al. Establishment and characterization of a novel reverse genetic system of BK polyomavirus[J]. J Med Virol, 2023, 95(8): e28995. DOI: 10.1002/jmv.28995. [6] GOVIND S, FRITZSCHE M, JENKINS A, et al. Deep sequencing and molecular characterisation of BK virus and JC virus WHO international reference materials for clinical diagnostic use[J]. Viruses, 2023, 15(6): 1289. DOI: 10.3390/v15061289. [7] ZHOU X, ZHANG S, FAN J, et al. Risk factors for BK virus-associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: a systematic review and meta-analysis[J]. Clin Transplant, 2023, 37(11): e15121. DOI: 10.1111/ctr.15121. [8] SALÁKOVÁ M, LUDVÍKOVÁ V, HAMŠÍKOVÁ E, et al. Pretransplantation seroreactivity in kidney donors and recipients as a predictive factor for posttransplant BKPyV-DNAemia[J]. Front Immunol, 2022, 13: 929946. DOI: 10.3389/fimmu.2022.929946. [9] HIRSCH HH, RANDHAWA P, AST Infectious Diseases Community of Practice. BK polyomavirus in solid organ transplantation[J]. Am J Transplant, 2013, 13(Suppl 4): 179-188. DOI: 10.1111/ajt.12110. [10] JAMBOTI JS. BK virus nephropathy in renal transplant recipients[J]. Nephrology (Carlton), 2016, 21(8): 647-654. DOI: 10.1111/nep.12728. [11] CHONG S, ANTONI M, MACDONALD A, et al. BK virus: current understanding of pathogenicity and clinical disease in transplantation[J]. Rev Med Virol, 2019, 29(4): e2044. DOI: 10.1002/rmv.2044. [12] HER T, SCHUTZBANK TE. Evaluation of the Luminex ARIES® system for the detection and quantification of BK virus (BKV) DNA in plasma samples from kidney transplant recipients[J]. Diagn Microbiol Infect Dis, 2019, 94(2): 129-134. DOI: 10.1016/j.diagmicrobio.2018.12.004. [13] FANG Y, ZHANG C, WANG Y, et al. Dynamic risk prediction of BK polyomavirus reactivation after renal transplantation[J]. Front Immunol, 2022, 13: 971531. DOI: 10.3389/fimmu.2022.971531. [14] QUERIDO S, WEIGERT A, PINTO I, et al. Detection of JCV or BKV viruria and viremia after kidney transplantation is not associated with unfavorable outcomes[J]. J Med Virol, 2023, 95(5): e28800. DOI: 10.1002/jmv.28800. [15] SAWINSKI D, GORAL S. BK virus infection: an update on diagnosis and treatment[J]. Nephrol Dial Transplant, 2015, 30(2): 209-217. DOI: 10.1093/ndt/gfu023. [16] IWASAKI S, TAKAHASHI K, KATANO H, et al. BK polyomavirus-associated urothelial carcinoma of the bladder with a background of BK polyomavirus nephropathy in a kidney transplant recipient[J]. Nephron, 2023, 147(Suppl 1): 53-60. DOI: 10.1159/000531822. [17] GREER AE, FORMAN MS, VALSAMAKIS A. Comparison of BKV quantification using a single automated nucleic acid extraction platform and 3 real-time PCR assays[J]. Diagn Microbiol Infect Dis, 2015, 82(4): 297-302. DOI: 10.1016/j.diagmicrobio.2015.04.006 . [18] FURMAGA J, KOWALCZYK M, ZAPOLSKI T, et al. BK polyomavirus-biology, genomic variation and diagnosis[J]. Viruses, 2021, 13(8): 1502. DOI: 10.3390/v13081502. [19] MUNJAL RS, MUNJAL J, GANDHI P, et al. BK polyomavirus-induced nephropathy in native kidney[J]. Cureus, 2023, 15(1): e34410. DOI: 10.7759/cureus.34410 . [20] CIEŚLIK A, BURBAN A, GNIEWKIEWICZ M, et al. The importance of 1-year protocol biopsy in the long-term prognosis of kidney transplants-5-years follow-up[J]. Transplant Proc, 2023, 55(9): 2053-2057. DOI: 10.1016/j.transproceed.2023.08.022. [21] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国实体器官移植受者BK病毒感染临床诊疗指南(2016版)[J/CD]. 中华移植杂志(电子版), 2017, 11(2): 65-69. DOI: 10.3877/cma.j.issn.1674-3903.2017.02.001.Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physician of Chinese Medical Doctor Association. Clinical diagnosis and treatment guidelines for BK virus infection of solid organ transplant recipients in China (2016 edition) [J/CD]. Chin J Transplant (Electr Edit), 2017, 11(2): 65-69. DOI: 10.3877/cma.j.issn.1674-3903.2017.02.001. [22] KASISKE BL, ZEIER MG, CHAPMAN JR, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary[J]. Kidney Int, 2010, 77(4): 299-311. DOI: 10.1038/ki.2009.377. [23] SHARMA R, TZETZO S, PATEL S, et al. BK virus in kidney transplant: current concepts, recent advances, and future directions[J]. Exp Clin Transplant, 2016, 14(4): 377-384. DOI: 10.6002/ect.2016.0030. [24] 王军祥, 王志强, 尚文俊, 等. 肾移植受体术后早期BK病毒感染的影响因素分析[J]. 中华实用诊断与治疗杂志, 2022, 36(6): 573-577. DOI: 10.13507/j.issn.1674-3474.2022.06.008.WANG JX, WANG ZQ, SHANG WJ, et al. Influencing factors of early BK virus infection in recipients after kidney transplantation[J]. J Chin Pract Diagn Ther, 2022, 36(6): 573-577. DOI: 10.13507/j.issn.1674-3474.2022.06.008. [25] KIEN TQ, KIEN NX, THANG LV, et al. Stepwise reduction of mycophenolate mofetil with conversion to everolimus for the treatment of active BKV in kidney transplant recipients: a single-center experience in Vietnam[J]. J Clin Med, 2022, 11(24): 7297. DOI: 10.3390/jcm11247297. [26] ZHOU X, ZHU C, LI H. BK polyomavirus: latency, reactivation, diseases and tumorigenesis[J]. Front Cell Infect Microbiol, 2023, 13: 1263983. DOI: 10.3389/fcimb.2023.1263983. [27] JUNG SW, CHO WH, SEO JW, et al. Urine exosomal BKV-miR-B1-5p and BK virus nephropathy in kidney transplant recipients[J]. J Infect Dis, 2023, 227(10): 1185-1193. DOI: 10.1093/infdis/jiac440. [28] SIM BZ, YONG KY, SLAVIN MA, et al. Risk factors and outcome of concurrent and sequential multiviral cytomegalovirus, Epstein-Barr virus, BK virus, adenovirus and other viral reactivations in transplantation[J]. Curr Opin Infect Dis, 2022, 35(6): 536-544. DOI: 10.1097/QCO.0000000000000888. [29] MINEEVA-SANGWO O, VAN LOON E, ANDREI G, et al. Time-dependent variations in BK polyomavirus genome from kidney transplant recipients with persistent viremia[J]. Sci Rep, 2023, 13(1): 13534. DOI: 10.1038/s41598-023-40714-4. [30] BAE H, JUNG S, CHUNG BH, et al. Pretransplant BKV-IgG serostatus and BKV-specific ELISPOT assays to predict BKV infection after kidney transplantation[J]. Front Immunol, 2023, 14: 1243912. DOI: 10.3389/fimmu.2023.1243912. [31] 乔良伟, 王凯, 李明, 等. 肾移植术后BK病毒感染患者血清、尿液BK病毒DNA载量与肾功能、免疫功能的相关性[J]. 东南大学学报(医学版), 2023, 42(5): 718-723. DOI: 10.3969/j.issn.1671-6264.2023.05.010.QIAO LW, WANG K, LI M, et al. Correlation of serum and urine BK virus DNA load with renal function and immune function in patients with BK virus infection after kidney transplantation[J]. J Southeast Univ (Med Sci Edit), 2023, 42(5): 718-723. DOI: 10.3969/j.issn.1671-6264.2023.05.010. [32] JI J, FENG S, JIANG Y, et al. Prevalence and risk factors of BK viremia and clinical impact of bk virus surveillance on outcomes in kidney transplant recipients: a single-center cross-sectional study[J]. Exp Clin Transplant, 2019, 17(6): 727-731. DOI: 10.6002/ect.2018.0262. [33] LIU Y, KONG C, HU H, et al. Risk factors for BK virus infection in DCD donor kidney transplant recipients[J]. Front Med (Lausanne), 2023, 10: 1181743. DOI: 10.3389/fmed.2023.1181743. [34] ZHAO Y, ZENG Y, LU R, et al. Rapid point-of-care detection of BK virus in urine by an HFman probe-based loop-mediated isothermal amplification assay and a finger-driven microfluidic chip[J]. PeerJ, 2023, 11: e14943. DOI: 10.7717/peerj.14943. [35] XU L, QU H, ALONSO DG, et al. Portable integrated digital PCR system for the point-of-care quantification of BK virus from urine samples[J]. Biosens Bioelectron, 2021, 175: 112908. DOI: 10.1016/j.bios.2020.112908. [36] AUGUSTINE R, HASAN A, DAS S, et al. Loop-mediated isothermal amplification (LAMP): a rapid, sensitive, specific, and cost-effective point-of-care test for coronaviruses in the context of COVID-19 pandemic[J]. Biology (Basel), 2020, 9(8): 182. DOI: 10.3390/biology9080182. [37] SZOBI A, BURANOVSKÁ K, VOJTAŠŠÁKOVÁ N, et al. Vivid COVID-19 LAMP is an ultrasensitive, quadruplexed test using LNA-modified primers and a zinc ion and 5-Br-PAPS colorimetric detection system[J]. Commun Biol, 2023, 6(1): 233. DOI: 10.1038/s42003-023-04612-9. [38] 韩健乐, 王长安, 刘金瑞. 肾移植随访质量规范化建设要点分析[J/CD]. 实用器官移植电子杂志, 2020, 8(2): 151-153. DOI: 10.3969/j.issn.2095-5332.2020.02.018.HAN JL, WANG CA, LIU JR. Analysis of key points for standardized construction of follow up quality in kidney transplantation[J/CD]. Pract J Organ Transplant (Electr Vers), 2020, 8(2): 151-153. DOI: 10.3969/j.issn.2095-5332.2020.02.018. -
下载:
点击查看大图
图(1) / 表(1)
计量
- 文章访问数: 26
- HTML全文浏览量: 32
- PDF下载量: 3
- 被引次数: 0
