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BK Virus Epidemiology, Risk Factors, and Clinical Outcomes: An Analysis of Hematopoietic Stem Cell Transplant Patients at Texas Children's Hospital.
Ruderfer, Daniel; Wu, Mengfen; Wang, Tao; Srivaths, Poyyapakkam R; Krance, Robert A; Naik, Swati; Bocchini, Claire E.
Affiliation
  • Ruderfer D; Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
  • Wu M; Biostatistics Shared Resource, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA.
  • Wang T; Biostatistics Shared Resource, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA.
  • Srivaths PR; Department of Pediatrics, Section of Nephrology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
  • Krance RA; Department of Pediatrics, Section of Hematology and Oncology, Bone Marrow/Stem Cell Transplant Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
  • Naik S; Department of Pediatrics, Section of Hematology and Oncology, Bone Marrow/Stem Cell Transplant Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
  • Bocchini CE; Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
J Pediatric Infect Dis Soc ; 10(4): 492-501, 2021 Apr 30.
Article in En | MEDLINE | ID: mdl-33416086
BACKGROUND: BK virus-associated hemorrhagic cystitis (BKV-HC) is a serious complication after hematopoietic stem cell transplantation (HSCT). METHODS: A retrospective review was performed to determine the frequency of BKV-HC and identify risk factors and renal morbidity associated with BKV-HC in pediatric HSCT recipients at our institution. RESULTS: A total of 314 pediatric recipients underwent allogeneic HSCT for either malignant (173, 55.1%) or nonmalignant disorders (141, 44.9%) from January 1, 2011, to December 31, 2015, with a minimum follow-up of 5 years post-HSCT. Severe BKV-HC (grades 3 and 4) was prevalent in 46 out of 67 (68.7%) recipients. Timing to presentation of severe BKV-HC (grades 3 and 4) occurred at a median of 37 days (26, 74; IQ1, IQ3) post-HSCT, with the duration of macroscopic hematuria lasting a median of 37.5 days (18, 71; IQ1, IQ3). In the first 60 days post-HSCT, peak acute kidney injury (AKI) stages 2 and 3 were seen more frequently in HSCT recipients who developed BKV-HC than those without (P = .004). Similarly, during post-HSCT days 61 to 100, peak AKI stage 3 was also more frequently seen in HSCT recipients who already developed BKV-HC prior to or during this time period than those without BKV-HC (P = .0002). Recipients who developed BKV-HC within 1 year of HSCT had more frequent mild to moderate chronic kidney disease (CKD stages 2-3) than those without BKV-HC (P = .002 and .007, respectively). On multivariate analysis, BKV-HC was associated with all-cause mortality (hazard ratio [HR]: 2.22; 95% confidence interval [CI]: 1.35-3.65). The following clinical variables were associated with time to development of HC on multivariate analysis: age (subdistribution HR [sHR] 1.11; 95% CI: 1.06-1.16) and myeloabalative conditioning regimen (sHR 4.2; 95% CI: 2.12-8.34). CONCLUSIONS: Pediatric HSCT patients with BKV-HC experience significant morbidity and mortality. Renal morbidity, including AKI and CKD, is associated with BKV-HC.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Tumor Virus Infections / BK Virus / Hematopoietic Stem Cell Transplantation / Cystitis / Polyomavirus Infections Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limits: Child / Humans Country/Region as subject: America do norte Language: En Journal: J Pediatric Infect Dis Soc Year: 2021 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Tumor Virus Infections / BK Virus / Hematopoietic Stem Cell Transplantation / Cystitis / Polyomavirus Infections Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limits: Child / Humans Country/Region as subject: America do norte Language: En Journal: J Pediatric Infect Dis Soc Year: 2021 Document type: Article Affiliation country: Country of publication: