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Abstract：
BACKGROUND: BK polyomavirus (BKPyV) infection after kidney transplantation can lead to serious complications such as BKPyV-associated nephropathy (BKPyVAN) and graft loss. The aim of this study was to investigate the incidence of BKPyVAN after implementing a BKPyV screening program, to map the distribution of BKPyV genotypes and subtypes in the Uppsala-Örebro region and to identify host and viral risk factors for clinically significant events.
METHODS: This single-center prospective cohort study included kidney transplant patients aged ≥ 18 years at the Uppsala University Hospital in Sweden between 2016 and 2018. BKPyV DNA was analyzed in plasma and urine every 3 months until 18 months after transplantation. Also genotype and subtype were determined. A logistic regression model was used to analyze selected risk factors including recipient sex and age, AB0 incompatibility and rejection treatment prior to BKPyVAN or high-level BKPyV DNAemia.
RESULTS: In total, 205 patients were included. Of these, 151 (73.7%) followed the screening protocol with 6 plasma samples, while184 (89.8%) were sampled at least 5 times. Ten (4.9%) patients developed biopsy confirmed BKPyVAN and 33 (16.1%) patients met criteria for high-level BKPyV DNAemia. Male sex (OR 2.85, p = 0.025) and age (OR 1.03 per year, p = 0.020) were identified as significant risk factors for developing BKPyVAN or high-level BKPyV DNAemia. BKPyVAN was associated with increased viral load at 3 months post transplantation (82,000 vs. < 400 copies/mL; p = 0.0029) and with transient, high-level DNAemia (n = 7 (27%); p < 0.0001). The most common genotypes were subtype Ib2 (n = 50 (65.8%)) and IVc2 (n = 20 (26.3%)).
CONCLUSIONS: Male sex and increasing age are related to an increased risk of BKPyVAN or high-level BKPyV DNAemia. BKPyVAN is associated with transient, high-level DNAemia but no differences related to viral genotype were detected.
METHODS: This single-center prospective cohort study included kidney transplant patients aged ≥ 18 years at the Uppsala University Hospital in Sweden between 2016 and 2018. BKPyV DNA was analyzed in plasma and urine every 3 months until 18 months after transplantation. Also genotype and subtype were determined. A logistic regression model was used to analyze selected risk factors including recipient sex and age, AB0 incompatibility and rejection treatment prior to BKPyVAN or high-level BKPyV DNAemia.
RESULTS: In total, 205 patients were included. Of these, 151 (73.7%) followed the screening protocol with 6 plasma samples, while184 (89.8%) were sampled at least 5 times. Ten (4.9%) patients developed biopsy confirmed BKPyVAN and 33 (16.1%) patients met criteria for high-level BKPyV DNAemia. Male sex (OR 2.85, p = 0.025) and age (OR 1.03 per year, p = 0.020) were identified as significant risk factors for developing BKPyVAN or high-level BKPyV DNAemia. BKPyVAN was associated with increased viral load at 3 months post transplantation (82,000 vs. < 400 copies/mL; p = 0.0029) and with transient, high-level DNAemia (n = 7 (27%); p < 0.0001). The most common genotypes were subtype Ib2 (n = 50 (65.8%)) and IVc2 (n = 20 (26.3%)).
CONCLUSIONS: Male sex and increasing age are related to an increased risk of BKPyVAN or high-level BKPyV DNAemia. BKPyVAN is associated with transient, high-level DNAemia but no differences related to viral genotype were detected.
摘要：
背景：肾移植后BK多瘤病毒（BKPyV）感染可导致严重并发症，如BKPyV相关性肾病（BKPyVAN）和移植物丢失。这项研究的目的是调查实施BKPyV筛查计划后BKPyVAN的发生率，绘制乌普萨拉-厄勒布鲁地区BKPyV基因型和亚型的分布图，并确定临床重大事件的宿主和病毒风险因素。
方法：这项单中心前瞻性队列研究包括2016年至2018年瑞典乌普萨拉大学医院年龄≥18岁的肾移植患者。每3个月在血浆和尿液中分析BKPyVDNA,直到移植后18个月。还确定了基因型和亚型。使用logistic回归模型分析选定的危险因素，包括接受者的性别和年龄，BKPyVAN或高水平BKPyVDNA血症之前的AB0不相容和排斥治疗。
结果：总计，205名患者被纳入。其中,151(73.7%)遵循6个血浆样本的筛选方案，而184（89.8%）被采样至少5次。10例（4.9％）患者出现活检证实BKPyVAN，33例（16.1％）患者符合高水平BKPyVDNA血症的标准。男性(OR2.85，p=0.025)和年龄(OR1.03/年，p=0.020）被确定为发生BKPyVAN或高水平BKPyVDNA血症的重要危险因素。BKPyVAN与移植后3个月的病毒载量增加相关（82,000vs.<400拷贝/毫升；p=0.0029)和瞬时，高水平的DNA血症（n=7（27%）；p<0.0001）。最常见的基因型是Ib2亚型（n=50（65.8％））和IVc2亚型（n=20（26.3％））。
结论：男性和年龄增长与BKPyVAN或高水平BKPyVDNA血症的风险增加有关。BKPyVAN与瞬态，检测到高水平的DNA血症,但未发现与病毒基因型相关的差异.
方法：这项单中心前瞻性队列研究包括2016年至2018年瑞典乌普萨拉大学医院年龄≥18岁的肾移植患者。每3个月在血浆和尿液中分析BKPyVDNA,直到移植后18个月。还确定了基因型和亚型。使用logistic回归模型分析选定的危险因素，包括接受者的性别和年龄，BKPyVAN或高水平BKPyVDNA血症之前的AB0不相容和排斥治疗。
结果：总计，205名患者被纳入。其中,151(73.7%)遵循6个血浆样本的筛选方案，而184（89.8%）被采样至少5次。10例（4.9％）患者出现活检证实BKPyVAN，33例（16.1％）患者符合高水平BKPyVDNA血症的标准。男性(OR2.85，p=0.025)和年龄(OR1.03/年，p=0.020）被确定为发生BKPyVAN或高水平BKPyVDNA血症的重要危险因素。BKPyVAN与移植后3个月的病毒载量增加相关（82,000vs.<400拷贝/毫升；p=0.0029)和瞬时，高水平的DNA血症（n=7（27%）；p<0.0001）。最常见的基因型是Ib2亚型（n=50（65.8％））和IVc2亚型（n=20（26.3％））。
结论：男性和年龄增长与BKPyVAN或高水平BKPyVDNA血症的风险增加有关。BKPyVAN与瞬态，检测到高水平的DNA血症,但未发现与病毒基因型相关的差异.
