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10.1371/journal.pone.0142460

http://scihub22266oqcxt.onion/10.1371/journal.pone.0142460
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suck abstract from ncbi


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pmid26544696
      PLoS+One 2015 ; 10 (11 ): e0142460
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  • Factors Influencing Graft Outcomes Following Diagnosis of Polyomavirus -Associated Nephropathy after Renal Transplantation #MMPMID26544696
  • Huang G ; Wu LW ; Yang SC ; Fei JG ; Deng SX ; Li J ; Chen GD ; Fu Q ; Deng RH ; Qiu J ; Wang CX ; Chen LZ
  • PLoS One 2015[]; 10 (11 ): e0142460 PMID26544696 show ga
  • BACKGROUND: Polyomavirus associated nephropathy (PVAN) is a significant cause of early allograft loss and the course is difficult to predict. The aim of this study is to identify factors influencing outcome for PVAN. METHODS: Between 2006 and 2014, we diagnosed PVAN in 48 (7.8%) of 615 patients monitored for BK virus every 1-4 weeks after modification of maintenance immunosuppression. Logistic or Cox regression analysis were performed to determine which risk factors independently affected clinical outcome and graft loss respectively. RESULTS: After 32.1±26.4 months follow-up, the frequencies of any graft functional decline at 1 year post-diagnosis, graft loss and any graft functional decline at the last available follow-up were 27.1% (13/48), 25.0% (12/48), and 33.3% (16/48), respectively. The 1, 3, 5 year graft survival rates were 100%, 80.5% and 69.1%, respectively. The mean level of serum creatinine at 1 year post-diagnosis and long-term graft survival rates were the worst in class C (p<0.05). Thirty-eight of 46 (82.6%) BKV DNAuria patients reduced viral load by 90% with a median time of 2.75 months (range, 0.25-34.0 months) and showed better graft survival rates than the 8 patients (17.4%) without viral load reduction (p<0.001). Multivariate logistic regression analysis showed that extensive interstitial inflammation (OR 20.2, p = 0.042) and delayed fall in urinary viral load (>2.75 months for >90% decrease) in urine (OR 16.7, p = 0.055) correlated with worse creatinine at 1 year post-diagnosis. Multivariate Cox regression analysis showed that extensive interstitial inflammation (HR 46988, p = 0.032) at diagnosis, and high PVAN stage (HR 162.2, p = 0.021) were associated with worse long-term graft survival rates. CONCLUSIONS: The extent of interstitial inflammation influences short and long-term graft outcomes in patients with PVAN. The degree of PVAN, rate of reduction in viral load, and viral clearance also can be used as prognostic markers in PVAN.
  • |*Kidney Transplantation [MESH]
  • |Adult [MESH]
  • |BK Virus/genetics/*physiology [MESH]
  • |DNA, Viral/blood/urine [MESH]
  • |Female [MESH]
  • |Humans [MESH]
  • |Immunosuppression Therapy [MESH]
  • |Kidney Diseases/diagnosis/immunology/*virology [MESH]
  • |Male [MESH]
  • |Polyomavirus Infections/diagnosis/immunology [MESH]
  • |Prognosis [MESH]
  • |Risk Factors [MESH]


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