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Nissreen Elfadawy Stuart M. Flechner Xiaobo Liu Jesse Schold Devin Tian Titte R. Srinivas Emilio Poggio Richard Fatica Robin Avery Sherif B. Mossad 《Transplant international》2013,26(8):822-832
We prospectively screened 609 consecutive kidney (538) and kidney‐pancreas (71) transplant recipients for BK viremia over a 4‐year interval using polymerase chain reaction viral load detection and protocol kidney biopsies. We found that BK viremia is common at our center: total cases 26.7%, cases during first year 21.3% (mean 4 months), and recipients with ≥10 000 copies/ml 12.3%. We found few predictive clinical or demographic risk factors for any BK viremia or viral loads ≥10,000 copies/ml, other than prior treatment of biopsy confirmed acute rejection and/or higher immunosuppressive blood levels of tacrolimus (P = 0.001) or mycophenolate mofetil (P = 0.007). Viral loads at diagnosis (<10 000 copies/ml) demonstrated little impact on graft function or survival. However, rising copy numbers demand early reductions in immunosuppressive drug doses of at least 30–50%. Viral loads >185 000 copies/ml at diagnosis were predictive of BK virus‐associated nephropathy (BKVAN; OR: 113.25, 95% CI: 17.22–744.6, P < 0.001). Surveillance for BK viremia and rapid reduction of immunosuppression limited the incidence of BKVAN to 1.3%. The addition of leflunomide or ciprofloxacin to immunosuppressive dose reduction did not result in greater rates of viral clearance. These data support the role of early surveillance for BK viremia to limit the impact on transplant outcome, although the most effective schedule for screening awaits further investigation. 相似文献
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Nissreen Elfadawy Stuart M. Flechner Jesse D. Schold Titte R. Srinivas Emilio Poggio Richard Fatica Robin Avery Sherif B. Mossad 《Clinical journal of the American Society of Nephrology》2014,9(3):553-561
Background and objectives
The objective was to study the long-term impact of transient versus persistent BK viremia on kidney transplant outcomes.Design, setting, participants, & measurements
In total, 609 recipients who underwent kidney transplant from 2007 to 2011 were screened at months 1–12 for the occurrence of polyomavirus BK viremia; 130 patients (21.7%) developed BK viremia during the first year post-transplant. BK viremia patients were classified according to duration of infection (more or less than 3 months), and BK viral loads (more or less than 10,000 copies/ml) were classified as transient low viremia (n=42), transient high viremia (n=18), persistent low viremia (n=23), and persistent high viremia (n=47). All patients were followed a median of 36 (3–66) months. The rates of BK polyomavirus–associated nephropathy, acute rejection, and 1-year graft function were compared with the polyomavirus BK–negative control group.Results
Patient and graft survival were not significantly different among the groups. Graft function (creatinine; milligrams per deciliter) at 1 year was significantly worse in the persistent high viremia (1.75±0.6) and transient high viremia (1.85±0.7) groups compared with aviremic controls (1.47±0.4; P=0.01 and P=0.01, respectively). The incidence of BK polyomavirus–associated nephropathy was limited to the persistent high viremia group (1.3%, P<0.001). The transient high viremia (50%) and persistent high viremia (34%) groups showed significantly (P=0.01) increased incidence of acute rejection versus aviremic controls (21.5%), transient low viremia (19%), or persistent low viremia (17.3%) groups.Conclusion
Low viral load BK viremia, either transient or persistent, was not associated with long-term transplant outcomes. Persistent high viremia was associated with a greater risk for BK polyomavirus–associated nephropathy and subsequent graft dysfunction. Although transient high viremia was not associated with BK polyomavirus–associated nephropathy, it was associated with worse graft function. These data support the role of surveillance for BK viremia after transplant. 相似文献4.
Jamil Azzi Giorgio Raimondi Valeria Mas Leonardo V. Riella Nissreen Elfadawy Kassem Safa David Wojciechowski Mazhar Kanak Rajat Nog Jonathan S. Maltzman Mandy L. Ford Jordan S. Pober Xung‐Rong Luo David Rothstein Michelle L. Miller David Matthews William Burlingham Megan Levings Peter Heeger Lauren Higdon John Gill Ronald G. Gill Maria‐Luisa Alegre 《American journal of transplantation》2018,18(1):271-272
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Paolo Cravedi Jesse D. Schold Kassem Safa Olivia S. Kates Nissreen Elfadawy Roslyn B. Mannon Malay B. Shah Sarah P. Hammond Robin Avery Cesar Guerrero Miranda Leonardo V. Riella Sheila Jowsey-Gregoire Enver Akalin Geoffrey Camirand Maria-Luisa Alegre Jamil Azzi 《Clinical transplantation》2020,34(11):e14059
An unprecedented global pandemic caused by a novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has quickly overwhelmed the health care systems worldwide. While there is an absence of consensus among the community in how to manage solid organ transplant recipients and donors, a platform provided by the American Society of Transplantation online community “Outstanding Questions in Transplantation,” hosted a collaborative multicenter, multinational discussions to share knowledge in a rapidly evolving global situation. Here, we present a summary of the discussion in addition to the latest published literature. 相似文献
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