Bänk virum svart
Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer.
Sittbänk & hallbänkar
BK virus associated nephropathy BKN is an important cause of kidney allograft failure. In a cohort of paediatric kidney transplant recipients, we aimed to understand the incidence and clinical outcome associated with BKN, as well as identify risk factors for BKN and BK viraemia development. We retrospectively analysed all patients who received a kidney transplant and received follow up care in our centre between — Among patients included in the study mean follow up 4.
The median time of BK viraemia development post-transplant was There was no difference in graft function at latest follow up between those who experienced BKN and those without BKN. This study demonstrates that BK virus infection is associated with younger age at transplantation, CMV negative recipient serostatus and higher levels of immunosuppression. Judicious monitoring of BK viraemia in paediatric transplant recipients, coupled with timely clinical intervention can result in similar long-term outcomes for BKN patients compared to controls.
Peripheral blood mononuclear cells disseminate BKPyV to the urinary tract where the virus establishes a persistent non-replicative latent phase in renal tubular epithelial cells and urothelium 34. The emergence of BKN in the last decade of the twentieth century coincided with the introduction of potent immunosuppressive agents such as tacrolimus and mycophenolate mofetil MMFleading to the proposal that a higher level of immunosuppression is a risk factor for the development of BKN 78.
Anti-viral agents have demonstrated minimal or no efficacy in clearing BKPyV 111213and treatment involves reducing immunosuppressive therapy to restore the capability of the host immune system to control BKPyV replication and prevent progression to BKN Reported risk factors for the development of BKN in the paediatric population include allograft recipient BKPyV seronegativity at time of transplantation 2023zero human leukocyte antigens HLA -A and -DR mismatches between transplant donor and recipient 22increased levels of immunosuppression, 821 younger age of recipient at transplantation 21and a tacrolimus- compared to ciclosporin- based immunosuppression regimen A recent study in adult kidney transplant recipients suggested prophylactic use of the anti-cytomegalovirus CMV agent valganciclovir may be associated with an increased risk of BKN In this single-centre study, we report our experience of BKN in a paediatric transplant recipient population over a year period, with patients predominantly receiving a steroid-sparing immunosuppressive regimen A total of patients met the requirements for inclusion in the study, with a mean follow up time of There were 7 graft failures mean time in months post-transplant: The mean median time of viraemia onset post-transplant in the bänk virum svart episodes of BKN Low was Characteristics of BKyPV viraemia episodes.
Red line indicates mean value for each group. Quartiles are plotted with median value in red. An overview of the temporal distribution of BK viraemia episodes is provided in Fig. No difference between length of viraemia per episode was noted between BKV Bänk virum svart subgroups mean Multinomial logistic analysis confirmed the univariate analysis findings of CMV recipient serostatus and age at time of transplant being independently predictive of BKN and BKPyV viraemia.
Change in net immunosuppression over time.
Praktiska och stilfulla hallbänkar
To understand how the total level of immunosuppression varied for patients across their post-transplant clinical course, a paediatric Vasudev score was calculated for all patients at latest follow up and, for relevant patients, at time of BKPyV viraemia onset. Additionally we quantified the bänk virum svart of immunosuppression for no-BKV patients at the mean time BKV All patients developed viraemia post-transplant days.
There was no significant difference in paediatric Vasudev score at latest follow up between no-BKV patients mean 4. Furthermore, immunosuppression level in no-BKV patients at days post-transplantation mean 5. This shows that patients who developed BKPyV viraemia were exposed to a higher level of immunosuppression at time of diagnosis than patients without BKPyV viraemia.
To understand if increases in immunosuppression following an episode of acute rejection may explain the higher paediatric Vasudev score recorded for BKV All patients, we examined whether BKPyV viraemia or acute rejection occurred first for each relevant patient.
BK virus infection and outcome following kidney transplantation in childhood
There was no significant difference in eCrCl between patient sub-groups at latest follow up or significant difference in the eCrCl percentage change from baseline to latest follow up between patient bänk virum svart Fig. Effect of BKPyV viraemia on graft function. Green arrows indicate points at which immunosuppressive therapy was reduced.
To analyse changes in kidney function during periods of viraemia, the eCrCl at BKPyV viraemia diagnosis was compared to the lowest eCrCl during the period of viraemia for each patient and a percentage change was calculated. Our graft outcome findings are similar to a prospective study of 62 paediatric transplants which reported no difference in SCr between patients who developed BKPyV viraemia and those who did not 36 months follow up post-transplantation Data from adult transplant recipients indicated that immunosuppression can safely be reduced in patients with BKPyV viraemia to prevent progression to BKN, without a concomitant increase in the incidence of acute rejection However, some paediatric data suggested an increased risk of BKPyV viraemia in patients who had experienced an episode of acute rejection These observations suggest that increases in immunosuppression due to rejection are unlikely to be a major contributor to BKPyV viraemia development in our cohort.
Rates of BKPyV viraemia in the current study exceed those found in the adult transplant population Indeed, we identified younger age at transplantation as a risk factor for BKN development. No definitive evidence exists demonstrating that primary BKPyV replication in seronegative individuals results in a poorer clinical outcome compared to secondary BKPyV replication in seropositive individuals 6.