BK DNAemia in pediatric kidney transplant recipients: Predictors and outcomes.
Pediatr Transplant
; 27(1): e14372, 2023 02.
Article
en En
| MEDLINE
| ID: mdl-35938684
ABSTRACT
BACKGROUND:
Pediatric data on risk factors and the clinical course of BK DNAemia are limited. We aimed to determine the effects of BK DNAemia on transplant outcomes and delineate the safety and efficacy of various treatment approaches.METHODS:
This retrospective-cohort study included 161 transplants (age ≤ 21 years) performed at a single center between 1/1/2012 and 1/1/2020. We used Cox proportional models to evaluate the effects of BK DNAemia on patient survival (PS), graft survival (GS), and acute rejection (AR), using BK as a time-dependent covariate. We also assessed the effects of pharmacological intervention on BK DNAemia duration using intervention as a time-dependent covariate.RESULTS:
BK-free survival was 69.1% at 1-year and 54.6% at 3-year posttransplant. After multivariate adjustment, BK DNAemia was associated with young age at transplant (aHR, age 5-<12 vs. ≥12 (years) 2.5 (1.4-4.5); p = .001) and steroid-based immunosuppression (IS) (aHR 2.2 [1.1-4.5]; p = .03). We found no effect of DNAemia on AR (aHR 1.25; p = .5), PS (aHR 2.85; p = .22), and GS (aHR 0.56; p = .41). Of 70 patients with DNAemia, 22 (31.4%) received no treatment, 20 (28.6%) received IS reduction alone, and 28 patients (40%) received treatment with at least one pharmacological agent (leflunomide, IVIG, ciprofloxacin, cidofovir). Sixty-three patients (90%) cleared DNAemia with median time to resolution of 2.4 months (IQR1.4-5.6). We found no significant effect of BK-directed pharmacological treatment on time to resolution (aHR 0.64;p = .13). BK-directed agents were well tolerated.CONCLUSIONS:
BK DNAemia is associated with a young age at transplant and steroid-based maintenance IS. We found no effect of BK DNAemia on AR, GS, and PS.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Infecciones Tumorales por Virus
/
Trasplante de Riñón
/
Virus BK
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Infecciones por Polyomavirus
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Child
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Child, preschool
/
Humans
Idioma:
En
Revista:
Pediatr Transplant
Asunto de la revista:
PEDIATRIA
/
TRANSPLANTE
Año:
2023
Tipo del documento:
Article
País de afiliación:
Estados Unidos