| Background:BK virus infection is a common viral infection after renal transplantation,the development of BKV associated nephropathy(BKVN)with the graft loss so concern about BKV infection transplant physicians,early screening found after renal transplantation and adjust the immune suppression scheme is considered to be the main method of prevention and treatment of BKV infection,the efficacy and safety of this method to be confirmed.Objective 1:To investigate the incidence of BKV infection stages after renal transplantation and adjustment scheme immunosuppressive clinical effect methods:the retrospective study,single center median follow-up time was 16 months(12~36 months),including between December 2015 and December 2018 to 629 in the center of the kidney transplant and regular follow-up monitoring of BKV infection in renal transplant recipients as the research object,statistical BKV infection incidence of each stage;In cases of BKV infection,the therapeutic effect was assessed by adjusting the immunization regimen.Objective 2:The clinical significance of active monitoring of BKV infection after kidney transplantation was discussed by retrospectively analyzing the clinical data of BKVN confirmed by pathology Method 1:The median follow-up time of this single-center retrospective study was 16months(12-36 months),including 629 kidney transplant recipients who received kidney transplantation in our center and regularly followed up to monitor BKVinfection from December 2015 to December 2018.In cases of BKV infection,the therapeutic effect was assessed by adjusting the immunization regimen.Methods 2:Among the 36 renal transplant recipients who were pathologically confirmed to be BKVN from 2013 to 2018 in our center,the study subjects were divided into active monitoring group(15 cases)and passive monitoring group(21 cases)according to their monitoring status of BKV infection,to analyze the influence of monitoring BKV infection and treatment on renal transplantation after kidney transplantation.Results 1:(1)BKV infection was regularly followed up and monitored in our center after the surgery,among which,154 recipients were found to have BKV infection during the follow-up after kidney transplantation,of which the detection rate of BKV urinalysis was 24.48%,the detection rate of BKV blood emia was 7.47%,and the detection rate of BKVN was 3.49%.(2)The treatment regimens and results of different stages of BKV infection are as follows:1 In patients with BKV uropathy at medium and low levels(n=30),the infection degree of BKV can be dynamically monitored by adopting a close follow-up observation program.At high level of BKV uropathy(n=124),a rapid immunosuppressant dosage reduction program was adopted to reduce the immunosuppression intensity.During the treatment,8.4% of the patients progressed to BKVN,while only 7.8% progressed to BKVN,and nearly 59.1% of the patients with uropathy were effectively controlled.2 Among the patients with bkvemia(n=47),44 patients chose the immunosuppressive conversion program,and the incidence of advanced BKVN was31.9%,and the serological negative conversion rate was 55.3 after treatment.3 All of the BKVN patients were treated with immunosuppressive conversion program combined with antiviral therapy,and 4 patients had renal graft loss,with the graft loss power of 18.1% and serological negative conversion rate of 54.5%.Results 2:(1)There was no statistical difference in the risk factors associated with BKV infection between the two groups(P>0.05).When the two groups were pathologically diagnosed as BKVN,both the urine and serum sustained a high level of BKVDNA replication,and the level of BKVDNA replication in the urine was greater than10^7copies/ml,up to 10^10copies/ml.The volume of BKVDNA replication in the active monitoring group was mainly distributed in 10^3~10^4copies/ml,while the volume of BKVDNA replication in the passive monitoring group was greater than10^4copies/ml.(2)The mean time of BKV urinalysis in the active monitoring group was significantly less than that in the control group.Pathocentesis confirmed that the time of BKVN was significantly less than that of the control group,and the difference was statistically significant(P<0.05).After pathological confirmation of BKVN,after adjustment of immunosuppression regimen,the negative conversion time of urine BKV and serum BKV in the subjective monitoring group was lower than that of the passive monitoring group,with significant differences(P<0.05).Meanwhile,the negative conversion rate of serum in the subjective monitoring group was higher than that of the passive monitoring group,with significant differences(P=0.039).After treatment,the serum graft renal function level of the active monitoring group was significantly better than that of the passive monitoring group,with significant difference and statistical significance(P<0.05).Conclusion 1:The detection rate of BKV uropathy was 24.48%,the detection rate of BKVN was 7.47%,and the detection rate of BKVN was 3.49%.The incidence of renal graft loss caused by BKVN was 54.5%.The incidence of BKVN uropathy and bkvemia was lower than the domestic and foreign research data.Different treatment regimens and effects in different stages of BKV infection:1 For patients with low level of BKV uria,a close follow-up observation program is adopted to dynamically monitor the degree of BKV infection.In patients with high level of BKV uria,rapid immunosuppressant dosage reduction program is adopted to reduce the immunosuppression intensity,which can reduce the occurrenceof BKV hemaemia and shorten the occurrence time of BKV hemaemia.2 In patients with bkvemia,immunosuppressive transformation is required,and the probability of progression to BKVN is significantly reduced.Meanwhile,the time of occurrence of BKVN and the time of graft loss are also delayed,which prolonging the survival time of the transplanted kidney,and the scheme has a good effect.3 However,once the progression to BKVN affects the renal function of transplantation,even if the immunosuppressant conversion is accompanied by immunoglobulin adjuvant therapy,although BKV replication can be cleared,the damage of renal function of transplantation is irreversible.Conclusion 2:With the application of immunosuppressive agents after kidney transplantation,BKV infection is prevalent,and the high incidence of BKV infection occurs within 1year after the operation.During this period,active and regular monitoring of BKV infection can detect the progress of BKV infection at an early stage,so as to gain an early chance to control the development of BKV.After treatment,subjective monitoring of BKV infection can significantly shorten the clearance time of urine-blood BKV,and significantly reduce the time and severity of kidney transplantation for BKV infection. |
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