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2015 ; 10
(11
): e0142460
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
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.