目的:本研究旨在评估EBV的存在,HCMV,和怀疑有排斥反应的肾移植受者的血浆样本(活动性感染/病毒血症)中的BKV基因组序列,并调查这些患者中与这些病毒激活相关的宿主和危险因素。
方法:在这项横断面单中心研究中,在拉巴菲内贾德医院收集了98名疑似肾移植排斥患者的血浆样本,德黑兰,伊朗,2022年12月至2023年6月。HCMV定量实时PCR检测,EBV,和BK使用GeneProof实时PCR试剂盒进行。ROC曲线分析用于确定每种病毒的病毒载量截止点。
结果:在18位(18.36%)受者中检测到HCMV活动性病毒血症,EBV活动性病毒血症7例(7.14%),BKV活动性病毒血症5例(5.10%)。ROC结果表明HCMV的病毒载量截止点分别为778、661和457点,EBV,和BKV,分别。活动性病毒血症组和非病毒血症组移植后的持续时间显着不同(120.5vs.46个月,P=0.014)。在BKV活动性病毒血症组中,与基线肌酐相比,肌酐的增加显着高于无病毒血症组(2.7vs.0.8,P=0.017)。服用他克莫司的患者HCMV活动性病毒血症的比值比高出2.84倍,服用抗胸腺细胞球蛋白的患者发生HCMV活动性病毒血症的几率是未服用这些药物的患者的3.01倍。
结论:快速及时诊断肾移植患者的病毒活动性感染对于有效的疾病管理和实施适当的治疗策略至关重要。识别潜在的风险因素,包括影响移植的宿主和治疗相关因素,可以促进制定合适的预防策略。
OBJECTIVE: This study aims to evaluate the presence of EBV, HCMV, and BKV genomic sequences in the plasma samples (active infection/viremia) of kidney transplant recipients suspected of rejection and to investigate host and risk factors related to the activation of these viruses in these patients.
METHODS: In this cross-sectional single-center study, plasma samples were collected from 98 suspected kidney transplant rejection patients at Labafinejad Hospital, Tehran, Iran, between December 2022 and June 2023. Quantitative real-time PCR assays for HCMV, EBV, and BK were performed using GeneProof Real-time PCR kits. ROC curve analysis was used to determine the viral load cutoff point for each virus.
RESULTS: HCMV active viremia was detected in 18 (18.36%) recipients, EBV active viremia in 7 (7.14%), and BKV active viremia in 5 (5.10%). ROC results indicated viral load cutoff points of 778, 661, and 457 points for HCMV, EBV, and BKV, respectively. The duration of time after transplantation significantly differed between active viremia and no viremia groups (120.5 vs. 46 months, P = 0.014). In the BKV active viremia group, the increase in creatinine compared to baseline creatinine was significantly higher than in the no viremia group (2.7 vs. 0.8, P = 0.017). The odds ratio of HCMV active viremia in patients taking tacrolimus was 2.84 times higher, and the odds of HCMV active viremia in patients taking antithymocyte globulin was 3.01 times higher than in patients not taking these drugs.
CONCLUSIONS: Rapid and timely diagnosis of viral active infections in kidney transplant patients is crucial for effective disease management and implementation of appropriate treatment strategies. Identifying potential risk factors, including host and treatment-related factors that influence transplantation, can facilitate the development of suitable preventive strategies.