背景:BK多瘤病毒(BKV)感染是肾移植后阻碍移植物存活的重要并发症。目的探讨小儿肾移植术后BKV感染的危险因素及转归。
方法:回顾性分析2015年1月至2023年6月复旦大学附属儿科医院小儿肾移植受者的临床及随访资料。
结果:共217例患者纳入研究,平均随访时间为24.3±19.9个月。移植时的平均年龄为9.7±4.2岁。患者存活率和移植物存活率分别为98.2%和96.8%,分别。29例患者(13.4%)发生BKV感染,移植后5.8±3.2个月检测到。在这29例BKV感染患者中,8例患者(3.6%)发生BKV肾病(BKVN),在移植后8.3±2.9个月诊断,2例患者最终出现移植失败。与非BKV感染组(eGFR76.7±26.1mL/min/1.73m2)和无BKVN感染组(eGFR85.2±23.8mL/min/1.73m2)比较,BKVN组随访期间eGFR最低(33.5±11.0ml/min/1.73m2,P<0.001)。移植时年龄较小(OR0.850,95CI0.762-0.948,P=0.005),CAKUT病的原发病因(OR2.890,95CI1.200-6.961,P=0.018),移植前CMV阴性受体血清状态(OR3.698,95CI1.583-8.640,P=0.003)是BKV感染的独立危险因素。
结论:儿童肾移植术后12个月内BKV感染的发生率相当高,BKVN患儿移植功能较差。移植时年龄较小,CAKUT病,移植前CMV阴性受体血清状态增加肾移植后BKV感染的风险。
BACKGROUND: BK polyomavirus (BKV) infection is a critical complication hindering graft survival after kidney transplantation. We aimed to investigate the risk factors and outcome of BKV infection in pediatric kidney transplantation.
METHODS: The clinical and follow-up data of pediatric kidney transplant recipients at the Children\'s Hospital of Fudan University from Jan 2015 to June 2023 were retrospectively analyzed.
RESULTS: A total of 217 patients were included in the study with mean follow-up time of 24.3 ± 19.9 months. The mean age at transplantation was 9.7 ± 4.2 years. The patient survival rate and graft survival rate were 98.2% and 96.8%, respectively. Twenty-nine patients (13.4%) developed BKV infection, which was detected at 5.8 ± 3.2 months after transplantation. Among these 29 patients with BKV infection, 8 patients (3.6%) developed BKV nephropathy (BKVN), which was diagnosed at 8.3 ± 2.9 months after transplantation, and 2 patients developed graft failure eventually. Compared with the non-BKV infection group (eGFR 76.7 ± 26.1 mL/min/1.73 m2) and BKV infection without BKVN group (eGFR 85.2 ± 23.8 mL/min/1.73 m2), BKVN group had lowest eGFR during follow-up (33.5 ± 11.0 ml/min/1.73 m2, P < 0.001). Younger age at transplant (OR 0.850, 95%CI 0.762-0.948, P = 0.005), CAKUT disease of primary etiology (OR 2.890, 95%CI 1.200-6.961, P = 0.018), and CMV negative recipient serostatus before transplantation (OR 3.698, 95%CI 1.583-8.640, P = 0.003) were independent risk factors for BKV infection.
CONCLUSIONS: Incidence of BKV infection is quite high within 12 months after pediatric kidney transplantation and children with BKVN have poor graft function. Younger age at transplant, CAKUT disease, and CMV negative recipient serostatus before transplantation increase the risk of BKV infection after kidney transplantation.