论文部分内容阅读
Background:BK virus-associated nephropathy (BKVN) is an important cause of chronic allograft dysfunction.The objective of our study was to evaluate the prognosis of BKVN.Methods:We retrospectively reviewed the data of 133 renal transplant recipients with BKVN treated at the First Affiliated Hospital of Sun Yat-Sen University between July 2007 and July 2017.BK viral loads,graft function,and pathologic indexes were compared between initial diagnosis and last follow-up.Results:After a mean follow-up period of 14.4 (range,0.3-109.6) months after diagnosis of BKVN,BK viruria,and BK viremia become negative in 19.5% and 90.2% of patients,respectively.The mean estimated glomerular filtration rate (eGFR) at last followup was lower than at diagnosis of BKVN (18.3 ± 9.2 vs.32.8 ± 20.6 mL.min-1.1.73 m-2,t =7.426,P < 0.001).Eight (6.0%) patients developed acute rejection after reducing immunosuppression.At last follow-up,the eGFR was significantly lower in patients with subsequent rejection than those without (21.6 ± 9.8 vs.33.5 ± 20.9 mL·min-1.73 m-2,t=3.034,P =0.011).In 65 repeat biopsies,SV40-T antigen staining remained positive in 40 patients and became negative in the other 20 patients.The eGFR (42.6 ± 14.3 vs.26.5 ± 12.3 mL.min-1 · 1.73 m-2),urine viral loads (median,1.3 × 105 vs.1.4 × 107 copies/mL),and plasma viral load (median,0 vs.0 copies/mL) were all significantly lower in patients with negative SV40-T antigen staining than those with persistent BK involvement (all,P < 0.05).Five (3.8%) recipients lost their graft at diagnosis of BKVN,and 13 (9.8%) lost their graft during the follow-up period.The 1-,3-,and 5-year graft survival rates after diagnosis of BKVN were 99.2%,90.7%,and 85.7%,respectively.Higher pathologic stage correlated with lower allograft survival rate (x2=6.341,P=0.042).Conclusion:Secondary rejection and persistent histologic infection in BKVN lead to poor prognosis.