Objective: To investigate the optimal time window for intervention of BK virus (BKV) replication and its effect on the outcomes of kidney transplant recipients (KTRs).
Methods: A retrospective analysis of the clinical data and treatment regimens was conducted among KTRs whose urine BKV load was ≥1.0×104 copies/mL following the operation between April, 2000 and April, 2015. KTRs with urine BKV load <1.0×104 copies/mL matched for transplantation time served as the control group.
Results: A total of 54 recipients positive for urine BKV were included in the analysis. According to urine BKV load, the recipients were divided into 3 groups: group A with urine BKV load of 1.0×104-1.0×107 copies/mL (n=22), group B with urine BKV load >1.0×107 copies/mL (n=24), and group C with plasma BKV load ≥1.0×104 copies/mL (n=8); 47 recipients were included in the control group. During the follow-up for 3.2-34.5 months, the urine and plasma BKV load was obviously lowered after intervention in all the 54 BKV-positive recipients (P<0.05). Eighteen (81.82%) of the recipients in group A and 19 (79.17%) in group B showed stable or improved estimated glomerular filtration rate (eGFR) after the intervention; in group C, 4 recipients (50%) showed stable eGFR after the intervention. In the last follow-up, the recipients in groups A and B showed similar eGFR with the control group (P>0.05), but in group C, eGFR was significantly lower than that of the control group (P=0.001). The recipients in group A and the control group had the best allograft outcome with stable or improved eGFR.
Conclusion: Early intervention of BKV replication (urine BKV load ≥1.0×104 copies/mL) in KTRs with appropriate immunosuppression reduction can be helpful for stabilizing the allograft function and improving the long-term outcomes.
目的: 探讨肾移植受者术后BK病毒（BKV）复制的干预时机及转归。
方法: 回顾性分析2012年4月~2015年4月在我院检测尿液BKV载量≥1.0×104/mL肾移植受者的临床资料，选择47例同期接受移植且尿液或血液BKV载量＜1.0×104/mL肾移植受者作为对照。
结果: 最终入组实验组54例：A组（尿BKV载量1.0×104~1.0×107/mL）22例，B组（尿BKV载量>1.0×107/mL）24例，C组（血BKV载量≥1.0×104/mL）8例; 对照组47例。经3.2~34.5个月的随访，实验组在干预后尿液、血浆BKV载量均明显降低（P值均＜0.05）。进一步比较干预前后估算肾小球滤过率（eGFR）水平，A组：18例（81.82%）eGFR稳定或好转，4例（18.18%）eGFR降低; B组：19例（79.17%）eGFR稳定或好转，5例（20.83%）eGFR降低; C组：4例（50%）eGFR稳定，4例（50%）eGFR降低。截止至末次随访，A组、B组的平均eGFR与对照组比较均无统计学差异（P值均≥0.05），C组的平均eGFR较对照组明显降低（P=0.001）。依各组移植肾eGFR变化趋势显示：干预后A组以及对照组随访期间移植效果最好，eGFR稳定，略呈上升状态。
结论: 在BKV复制早期（尿液BKV≥1.0×104/mL）就予以干预，进行适度的免疫抑制剂减量，有利于稳定移植肾功能，改善移植肾长期存活。