Kidney Transplant Recipients with JC Virus Infection Have Decreased Function of the Transplanted Kidney

Abstract

We conducted a survey on the status of patients after kidney transplantation infected with JC virus (JCV), at 108 Military Central Hospital (108MCH), Vietnam, combining research on the effects of JCV infection on transplanted kidney function and understanding the risk factors for JCV infection in kidney transplant recipients. Patients and Methods: A single-center cohort study was conducted in the period from March 2021 to July 2022, using a combination of retrospective and prospective methods, with longitudinal follow-up of 94 eligible kidney transplant patients who agreed to participate, at the Department of Nephrology and Dialysis, 108MCH, Vietnam. Patients undergo monthly health checks and have their blood and urine tested by a real-time PCR method, with TaqMan probes (BioRad, USA). If at least one of the two specimens (blood or urine sample) is positive for JCV (when JCV is quantified in blood or urine samples at >250 copies/mL), the patient is confirmed to have JCV infection in any part or tissue of the body. Factors of JCV infection, such as age, gender, donor source, and immunosuppressive therapy, along with demographic and clinical data and JCV infection status, were analyzed using multivariable Cox-regression analysis. The estimated glomerular filtration rate (eGFR) was selected as an indicator of kidney function, and the difference in eGFR between JCV-infected patients and non-infected patients was compared using the t-test. This study was approved by the Research Ethics Committee. Results: JCV was detected in 71.3% of kidney transplant patients. Differences in eGFR were observed between the JCV-infected and non-infected patient groups (64.47±25.70 and 70.89±28.80 mL/min/1.73 m 2 for each group; independent t-test; t=−6.079; p=0.00). Factors such as kidney donor (HR=0.086; 95% confidence interval [CI]: 0.008-0.936; p=0.04), tacrolimus trough level (HR=1.083; 95% CI: 1.069-1.097; p=0.00), mycophenolate dose (HR=1.002; 95% CI: 1.002-1.001; p=0.00) and prednisone dose (HR=1.001; 95% CI: 1.000-1.001; p=0.00) in the trio of immunosuppressants tacrolimus + mycophenolate mofetil (MMF) + prednisone (multivariable Cox-regression analysis) are potential risk factors for JCV infection in renal transplantation. JCV infection in kidney transplant patients lowers the eGFR, leading to decreased transplant kidney function (independent t-test, p=0.00). Conclusion:The level of JCV infection in kidney transplant patients in our study is quite high (71.3%). Using an immunosuppressive regimen that uses the trio of immunosuppressants tacrolimus + MMF + prednisone, and having a donor source element are potential risk factors for JCV infection in renal transplantation. The function of the transplanted kidney is reduced by JCV infection in kidney transplant patients in the short term. The timely diagnosis and treatment of JCV can ensure the stable and long-term function of transplanted kidneys in kidney transplant patients.