摘要
目的比较活体肾移植与尸体肾移植术后早期两组受者间BK病毒感染状况,并评价他克莫司谷浓度对两组受者BK病毒感染的影响。方法回顾性分析2017年1月至2018年5月在郑州大学第一附属医院接受肾移植手术并且术后24个月内规律监测BK病毒的535例受者的临床资料,根据供肾来源分为活体肾移植99例和尸体肾移植436例,对术后早期两组受者间BK病毒尿症、持续BK病毒尿症、BK病毒血症、BK病毒肾病、急性排斥反应和新生供者特异性抗体的累积发生率以及移植肾功能进行比较,同时分析两组受者的他克莫司谷浓度对BK病毒感染的影响。结果随访24个月,尸体肾移植受者术后尿液中BK病毒DNA>107拷贝数/ml的累积发生率明显高于活体肾移植组,而两组间BK病毒尿症、BK病毒血症、持续BK病毒尿症、术后急性排斥反应和新生供者特异性抗体的累积发生率差异均无统计学意义(P>0.05)。术后1个月时,两组间BK病毒尿症的他克莫司谷浓度差异无统计学意义,但均较BK病毒阴性组受者升高(P<0.05),而在术后3、6、9、12、15、18、21、24个月时,三组间他克莫司谷浓度差异无统计学意义(P>0.05)。逻辑回归分析发现术后1个月时的他克莫司谷浓度是BK病毒感染的危险因素。在术后12个月和24个月,活体肾移植和尸体肾移植的BK病毒尿症、持续BK病毒尿症、尿液中BK病毒DNA>107拷贝数/ml以及BK病毒血症受者的血清肌酐和估算的肾小球滤过率与BK病毒阴性组比较,三组间差异均无统计学意义(P>0.05)。结论尸体肾移植受者术后尿液中BK病毒DNA>107拷贝数/ml的2年累积发生率明显高于活体肾移植组,两组间BK病毒尿症、BK病毒血症、持续BK病毒尿症、急性排斥反应以及新生供者特异性抗体的累积发生率相近。尿中BK病毒持续状态和高BK病毒复制以及BK病毒血症并不影响术后的移植肾功能。术后1个月时的他克莫司谷�
Objective To compare the incidence of early BKV-related diseases after kidney transplantation between living donor kidney and DD donor kidney and evaluate the effect of tacrolimus(Tac)trough concentration on BKV infection between two groups.Methods Retrospective analysis was performed for 535 adult kidney transplant recipients monitored for BKV load within 24 months after transplantation from January 2017 to May 2018.The recipients were of living-related(n=99)and deceased donor(DD,n=436).The cumulative incidence of early BK viruria,persistent BK viruria,BK viremia,BK viral nephropathy,acute rejection,de novo anti-donor specific antibody(dnDSA)and effects on graft function were compared between two groups after transplantation.And the effects of Tac trough concentration on BKV infection were analyzed between two groups.Results During a follow-up period of 24 months,the cumulative incidence of peak BK viral DNA>107 copies/ml in urine in DD kidney transplantation group was significantly higher than that in living-related kidney transplantation group.No statistically significant inter-group differences existed in the cumulative incidence of BK viruria,persistent BK viruria,BK viremia,acute rejection or dnDSA(P>0.05).At Month 1,no inter-group statistical difference existed in Tac trough concentration of BK viruria.Both were higher than those of BKV negative recipients(P<0.05).At Month 3/6/9/12/15/18/21/24,no significant difference existed in Tac trough concentration among three groups(P>0.05).Logistic regression analysis revealed that Tac trough concentration at 1 month was a risk factor for BKV infection.Serum creatinine level and estimated glomerular filtration rate(eGFR)of living-related and DD recipients with BK viruria,persistent BK viruria,BKV DNA in urine>107 copies/ml and BK viremia at Month 12/24 were not statistically significant as compared with those of BKV-negative recipients(P>0.05).Conclusions At Month 24,the cumulative incidence of urinary BKV DNA>107 copies/ml is significantly higher in DD recipients
作者
王军祥
王志刚
杨先雷
丰永花
谢红昌
刘磊
李金锋
庞新路
张彦选
丰贵文
尚文俊
Wang Junxiang;Wang Zhigang;Yang Xianlei;Feng Yonghua;Xie Hongchang;Liu Lei;Li Jinfeng;Pang Xinlu;Zhang Yanxuan;Feng Guiwen;Shang Wenjun(Department of Kidney Transplantation,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)
出处
《中华器官移植杂志》
CAS
北大核心
2020年第10期597-602,共6页
Chinese Journal of Organ Transplantation
基金
郑州大学第一附属医院青年基金(YNQN2017097)。
