Replikation von Epstein-Barr-Virus, Cytomegalievirus und Humanem Polyomavirus bei Patienten nach Nierentransplantation unter Immunsuppression mit Belatacept [thesis]

Anna Dornig, Universitätsbibliothek Der FU Berlin
Infections after transplantation under immunosuppressant therapy are one of the biggest challenges in today's transplant medicine. During the follow-up after transplantation particularly Epstein-Barr-Virus, Cytomegalovirus and BK Virus matter. Belatacept is a new immunosuppressive drug which is an alternative to immunosuppression with Calcineurin-Inhibitors. This work compares a Belatacept-based immunosuppressive regimen with standard immunosuppression, regarding the replication of the
more » ... ion of the Epstein-Barr-Virus, Cytomegalovirus and BK Virus. The underlying research is a retrospective data analysis of 91 patients with a Belatacept-based immunosuppressive regimen and 91 patients under standard immunosuppression. The virological data was descriptively analysed during the period of 24 month before, until 68 month after conversion to Belatacept. Furthermore a survival analysis was calculated of the events first virus replication after conversion to Belatacept, death and graft loss. Regarding the overall replication, Epstein-Barr-Virus und Cytomegalovirus replicated higher under Belatacept. BK Virus replicated less under Belatacept. The overall replication of Epstein-Barr-Virus in the BG was clearly higher with 277,671 cop/mL in comparison to 46,770 cop/mL in the CG. In the BG 29/91 patients (31%) replicated, in the CG 5/91 patients (5.5%) replicated (p<0.05). The overall replication of Cytomegalovirus under Belatacept was 6,206,010 cop/mL of 9/91 patients (9.9%) as opposed to 713,120 cop/mL of 7/91 patients (7.7%) in the CG, whereas the number of patients that replicated did not differ significantly (p=0.601). On the contrary, after analysis we could state that the overall replication of BK Virus in urine was considerably lower with 583 x 106 cop/mL in the BG related to the CG with 42,212 x 106 cop/mL. In both groups 14/91 (15.4%) patients replicated in urine. In plasma the difference between the two groups was even higher with 86,660 cop/mL in the BG and 50,035 x 106 cop/mL in the CG. In the BG just 1/91 patient (1.2%) h [...]
doi:10.17169/refubium-29712 fatcat:cmwkgytkavexzh4szle7wviqzy