A Nomogram for Predicting BK Virus Activation in Kidney Transplantation Recipients Using Clinical Risk Factors.

Jiyan Wang,Tongyu Zhu,Ming Xu,Ruiming Rong,Cheng Yang,Jiawei Li,Zhongli Chen

doi:10.3389/fmed.2022.770699

Abstract

BK virus is a common opportunistic viral infection that could cause BK virus-associated nephropathy in renal transplant recipients. Thus, we retrospectively analyzed clinical and laboratory data associated with a higher risk of BK virus activation from 195 renal transplant recipients by the multivariate logistic regression analysis and performed the external validation. Results showed that patients with BK virus active infection were associated with a deceased donor, had lower direct bilirubin levels, a higher proportion of albumin in serum protein electrophoresis, and lower red blood cells and neutrophil counts. The multivariate logistic regression analyses revealed that the living donor, direct bilirubin, and neutrophil counts were significantly associated with BK virus activation. The logistic regression model displayed a modest discriminability with the area under the receiver operating characteristic curve of 0.689 (95% CI: 0.607–0.771; P < 0.01) and also demonstrated a good performance in the external validation dataset (the area under the receiver operating characteristic curve was 0.699, 95% CI: 0.5899–0.8081). The novel predictive nomogram achieved a good prediction of BK virus activation in kidney transplant recipients.

Highlights

BK virus (BKV) is a common post-transplant opportunistic viral infection that can cause interstitial nephritis and allograft failure in renal transplant recipients (RTRs) [1, 2]
There are 65 patients with BKV-DNA positive in urine or plasma and 42 of them were in virus activation according to virus load
The two groups did not differ with respect to gender, age, the history of diabetes, coronary heart disease, hypertension, transfusion, malignancy, hyperlipemia, viral hepatitis, the information of transplantation times, ABO compatible, ischemia time, acute rejection or delayed graft function history, induction treatment, initial immunosuppressive protocol, the levels of total bilirubin, total protein, globulin, alanine aminotransferase, aspartate aminotransferase, creatine, urea nitrogen, uric acid, estimated glomerular filtration rate (eGFR) in serum, the proportion of serum α1, α2, β, γ protein in serum protein electrophoresis (SPE), the count of platelet, neutrophils, lymphocytes, and monocytes in peripheral blood and urine protein semiquantitative levels

Summary

Introduction

BK virus (BKV) is a common post-transplant opportunistic viral infection that can cause interstitial nephritis and allograft failure in renal transplant recipients (RTRs) [1, 2]. With the progress of the immunosuppressive regimen, acute rejection incidence decreased. Viral infections after renal transplantation are still a hurdle, which causes chronic allograft loss. BKV is one member of the polyomavirus family, which was first described in 1971 in the urine of an RTR with ureteric stenosis. BKV has circular nucleic acid and double-stranded DNA [3]. The transmission mechanism of BKV is unclear but supposed through the mouth and respiratory tract [4]

Methods

Results

Conclusion