Frontiers in Medicine (Jul 2023)

Risk factors for BK virus infection in DCD donor kidney transplant recipients

  • Yiting Liu,
  • Yiting Liu,
  • Chenyang Kong,
  • Chenyang Kong,
  • Haochong Hu,
  • Haochong Hu,
  • Yalong Zhang,
  • Yalong Zhang,
  • Tianyu Wang,
  • Tianyu Wang,
  • Tao Qiu,
  • Tao Qiu,
  • Jiangqiao Zhou,
  • Jiangqiao Zhou

DOI
https://doi.org/10.3389/fmed.2023.1181743
Journal volume & issue
Vol. 10

Abstract

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BackgroundBK virus infection after kidney transplantation can negatively impact the prognosis of patients. However, current risk factor analyses primarily focus on BK virus nephropathy, while BK viruria and BK viruria progressing to BK viremia receive less attention. This study aims to analyze the risk factors associated with BK viruria and BK viruria progressing to BK viremia in recipients of donation after cardiac death (DCD), with the goal of facilitating early intervention.MethodsDonor characteristics and clinical data of recipients before and after transplantation were evaluated, and logistic univariate and multivariate analyses were performed to determine the risk factors associated with BK viruria and the progression of BK viruria to BK viremia. Additionally, machine learning techniques were employed to identify the top five features associated with BK viruria evolving into BK viremia.ResultsDuring a median follow-up time of 1,072 days (range 739–1,418), 69 transplant recipients (15.6% incidence rate) developed BK viruria after transplantation, with 49.3% of cases occurring within 6 months post-transplantation. Moreover, 19 patients progressed to BK viremia. Donor age [OR: 1.022 (1.000, 1.045), p = 0.047] and donor procalcitonin (PCT) levels [0.5–10 ng/ml; OR: 0.482 (0.280, 0.828), p = 0.008] were identified as independent risk factors for BK viruria. High BK viruria [OR: 11.641 (1.745, 77.678), p = 0.011], recipient age [OR: 1.106 (1.017, 1.202), p = 0.018], and immunoinduction regimen [ATG; OR: 0.063 (0.006, 0.683), p = 0.023] were independent risk factors for BK viruria progressing to BK viremia. Machine learning analysis confirmed the importance of high BK viruria, recipient age, and immunoinduction regimen (ATG) in predicting the progression of BK viruria to BK viremia.ConclusionThe development and progression of BK virus in DCD kidney transplant recipients is influenced by multiple factors. Early intervention and treatment could potentially extend the lifespan of the transplanted organ.

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