Peritubular and Tubulointerstitial Inflammation as Predictors of Impaired Viral Clearance in Polyomavirus Nephropathy

被引:0
|
作者
Omic, Haris [1 ]
Eder, Michael [1 ]
Schrag, Tarek A. [1 ]
Kozakowski, Nicolas [2 ]
Klaeger, Johannes [2 ]
Bond, Gregor [1 ]
Kikic, Zeljko [3 ]
机构
[1] Med Univ Vienna, Dept Med 3, Div Nephrol & Dialysis, A-1090 Vienna, Austria
[2] Med Univ Vienna, Dept Pathol, A-1090 Vienna, Austria
[3] Med Univ Vienna, Dept Urol, A-1090 Vienna, Austria
关键词
kidney transplantation; polyomavirus; inflammation; peritubular capillaritis; PVN; BK VIRUS-INFECTION; HISTOLOGICAL EVOLUTION; TRANSPLANTATION; DONOR;
D O I
10.3390/jcm13195714
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Polyomavirus-associated nephropathy (BKPyVAN) is a common complication in kidney transplant recipients. The histological changes in the context of BKPyVAN and their association with the viral load and outcomes are still being investigated. Methods: This retrospective study involved 100 adult patients transplanted between 2000 and 2021, with available archived biopsy slides, aiming to analyze associations between viral load clearance in the blood (reduction in BKPyVAN-DNAemia below detection level) and histological features in biopsy-proven BKPyVAN. A kidney pathologist blinded to the clinical data reassessed the BANFF 2019 lesion scores in the BKPyVAN index biopsy. The primary endpoint was viral clearance three months after the diagnosis. Results: The presence of tubulointerstitial inflammation, peritubular capillaritis, and higher PVN Class at the diagnosis was linked to a reduced likelihood of viral clearance three months later (interstitial inflammation OR = 0.2, 95% CI [0.07-0.55], tubulitis OR = 0.39, 95% CI [0.21-0.73], peritubular capillaritis OR = 0.25, 95% CI [0.08-0.82], PVN Score OR = 0.1, 95% CI [0.03-0.4]), independently of other covariates. Combining the four lesions using the ROC analysis enhanced their capability to predict persistent BK viremia after 3 months with an AUC of 0.94. Conclusions: The presence of interstitial inflammation, tubulitis, and peritubular capillaritis, as well as the higher PVN Score, was associated with an up to 90% lower likelihood of viral load clearance three months post-diagnosis. These findings underscore the importance of histological evaluation as a surrogate of subsequent viral clearance and offer valuable insights for the management of BKPyVAN.
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页数:18
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