Characteristics, risk factors and outcome of BKV nephropathy in kidney transplant recipients: a case-control study.

Autor: Gras J; Infectious Disease Department, APHP-Saint Louis Hospital, 1 Avenue Claude Vellefaux, Paris, France. julien.gras@aphp.fr.; INSERM U944, «Biology of Emerging Viruses» Team, Institut de Recherche Saint Louis, APHP-Saint Louis Hospital, Paris, France. julien.gras@aphp.fr.; Université Paris Cité, Paris, France. julien.gras@aphp.fr., Le Flécher A; Nephrology and Kidney Transplant Department, APHP-Saint Louis Hospital, Paris, France., Dupont A; Biostatistics and Medical IT Department, APHP-Saint-Louis Hospital, Paris ECSTRA Team, UMR 1153 INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France., Vérine J; Pathology Department, APHP-Saint Louis Hospital, Paris, France., Amara A; INSERM U944, «Biology of Emerging Viruses» Team, Institut de Recherche Saint Louis, APHP-Saint Louis Hospital, Paris, France., Delaugerre C; INSERM U944, «Biology of Emerging Viruses» Team, Institut de Recherche Saint Louis, APHP-Saint Louis Hospital, Paris, France.; Université Paris Cité, Paris, France.; Virology Department, APHP-Saint Louis Hospital, Paris, France., Molina JM; Infectious Disease Department, APHP-Saint Louis Hospital, 1 Avenue Claude Vellefaux, Paris, France.; INSERM U944, «Biology of Emerging Viruses» Team, Institut de Recherche Saint Louis, APHP-Saint Louis Hospital, Paris, France.; Université Paris Cité, Paris, France., Peraldi MN; Université Paris Cité, Paris, France.; Nephrology and Kidney Transplant Department, APHP-Saint Louis Hospital, Paris, France.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2023 Feb 06; Vol. 23 (1), pp. 74. Date of Electronic Publication: 2023 Feb 06.
DOI: 10.1186/s12879-023-08043-z
Abstrakt: Background: Following kidney transplantation, BK virus associated nephropathy (BKVN) occurs in 1 to 10% of kidney transplant recipients (KTR) and represents a major cause of graft loss. We aim at identifying factors associated with biopsy proven BKVN among KTR.
Methods: We conducted a retrospective case-control study including all KTR with a biopsy-proven diagnosis of BKVN between 2005 and 2019. Clinical characteristics and outcome were described. For each case, one control KTR without BKV infection was identified and matched by age, transplant date, and donor status. Factors associated with BKVN diagnosis were identified using exact conditional logistic regression. Comparative survival was described using Kaplan-Meier estimator.
Results: Sixty-four cases of BKVN were identified among 1737 new kidney transplantation (3.7% prevalence). Clinical characteristics did not differ between groups, except for a higher c-PRA among cases. BKVN occurred in a median time of 11 (5-14.5) months after KT, and was associated with a significantly impaired graft function at diagnosis. Following BKVN, 61 (95%) of the patients had immunosuppression reduction, which led to BKV DNAemia resolution in 49% of cases. In multivariate analysis, factors associated with BKVN diagnosis were lymphopenia < 500/mm 3 and a prednisone dose > 7.5 mg/day. Median duration of follow-up was 40 months for both groups. BKVN was associated with a significantly increased risk of graft rejection (P = 0.02) and return to dialysis (P = 0.01).
Conclusions: BKVN remains a severe complication in KTR and is associated with an increased risk for acute rejection and return to dialysis. Lymphopenia below 500/mm 3 and corticosteroid maintenance therapy are significantly associated with biopsy-proven BKVN diagnosis.
(© 2023. The Author(s).)
Databáze: MEDLINE
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