Kidney international · 2025
A systematic literature review and meta-analysis evaluated modifiable risk factors for the development of BK polyoma virus-associated complications.
СтатьяСистематический обзорМетаанализПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Eder Michael, Kainz Alexander, Omic Haris, Aigner Christof, Copic Dragan, Kotton Camille N, Kamar Nassim, Wojciechowski David, Hirsch Hans H, Oberbauer Rainer
Аннотация
BACKGROUND: BK polyomavirus-associated nephropathy (BKPyVAN) remains a significant cause of kidney graft injury. Several risk factors are suggested, mostly based on monocentric or retrospective studies. By performing a systematic literature review and comprehensive meta-analysis we sought to provide solid assumptions and test the reproducibility of known modifiable clinical risk factors for BKPyV.
METHODS: Literature search included Medline, Embase and Cochrane Register of Controlled Trials. Research question was defined with PICOTS framework. Pro- and retrospective clinical studies reporting BKPyV complications in adult kidney transplant recipients were included. Odds, hazard, or risk ratios were directly extracted or calculated. Endpoints were biopsy-proven-, presumptive BKPyVAN, BKPyV-DNAemia and events leading to treatment. Pooled risks were calculated with random effects models. Bias risks were assessed with QUIPS tools, funnel plots and I2 statistics.
RESULTS: We identified 6,690 publications and included 165 encompassing 197,029 total patients. Twenty-nine studies were graded as high risk for bias. The number of included studies was highest for anti-thymocyte globulin vs. IL-2RA (78 studies), tacrolimus versus cyclosporine (54 studies), and ABO-incompatible transplantation (32 studies). Corticosteroids were significantly associated with three out of four endpoints: tacrolimus and anti-thymocyte globulin with two, and tacrolimus levels, blood group ABO-incompatible transplantation, rituximab, mycophenolate mofetil, mTOR inhibitors, and ureteral stents with one each.
CONCLUSIONS: We were not able to identify a single independent risk factor for all endpoints, reflecting the complexity in predicting BKPyV-related complications in kidney transplant recipients. Rather than a single drug or procedure, insufficient net immune control over BKPyV replication in donor kidney may significantly promote BKPyV complications.
METHODS: Literature search included Medline, Embase and Cochrane Register of Controlled Trials. Research question was defined with PICOTS framework. Pro- and retrospective clinical studies reporting BKPyV complications in adult kidney transplant recipients were included. Odds, hazard, or risk ratios were directly extracted or calculated. Endpoints were biopsy-proven-, presumptive BKPyVAN, BKPyV-DNAemia and events leading to treatment. Pooled risks were calculated with random effects models. Bias risks were assessed with QUIPS tools, funnel plots and I2 statistics.
RESULTS: We identified 6,690 publications and included 165 encompassing 197,029 total patients. Twenty-nine studies were graded as high risk for bias. The number of included studies was highest for anti-thymocyte globulin vs. IL-2RA (78 studies), tacrolimus versus cyclosporine (54 studies), and ABO-incompatible transplantation (32 studies). Corticosteroids were significantly associated with three out of four endpoints: tacrolimus and anti-thymocyte globulin with two, and tacrolimus levels, blood group ABO-incompatible transplantation, rituximab, mycophenolate mofetil, mTOR inhibitors, and ureteral stents with one each.
CONCLUSIONS: We were not able to identify a single independent risk factor for all endpoints, reflecting the complexity in predicting BKPyV-related complications in kidney transplant recipients. Rather than a single drug or procedure, insufficient net immune control over BKPyV replication in donor kidney may significantly promote BKPyV complications.