Polyomavirus Nephropathy: Ten-Year Experience
| Autor: | Amintas F. S. Figueiredo, Rita Leal, Jorge Pratas, Rui Alves, M. Campos, Catarina Romãozinho, N. Bota, Vitor Sousa, F. Macário, Joana Silva Costa, Lídia Santos, Carol Marinho, Emanuel Ferreira |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Inibidores de Calcineurina/efeitos adversos medicine.medical_specialty Time Factors medicine.medical_treatment Calcineurin Inhibitors 030232 urology & nephrology Delayed Graft Function Renal function 030230 surgery Transplantação de Rim Tacrolimus 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Internal medicine Diabetes mellitus medicine Humans Postoperative Period Dialysis Retrospective Studies Immunosuppression Therapy Polyomavirus Infections Transplantation business.industry Graft Survival Hazard ratio Retrospective cohort study Immunosuppression Middle Aged Allografts medicine.disease Kidney Transplantation Discontinuation Surgery Calcineurin BK Virus Disease Progression Female Kidney Diseases Polyomavirus business Doenças do Rim Imunossupressão Glomerular Filtration Rate |
| Popis: | BACKGROUND: Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL). METHODS: Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was 60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis. CONCLUSIONS: GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL. info:eu-repo/semantics/publishedVersion |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|