A systematic literature review and meta-analysis evaluated modifiable risk factors for the development of BK polyoma virus-associated complications.

Several risk factors are suggested, mostly based on monocentric or retrospective studies.

已提出多种风险因素，主要基于单中心或回顾性研究。

By performing a systematic literature review and comprehensive meta-analysiswe sought to provide solid assumptions and test the reproducibility of known modifiable clinical risk factors for BKPyV.

通过进行系统性的文献回顾和全面的荟萃分析，我们旨在提供坚实的假设，并测试已知可修改的临床风险因素对于BKPyV的可重复性。

Methods

Literature search included Medline, Embase and Cochrane Register of Controlled Trials.

文献搜索包括Medline、Embase和Cochrane对照试验注册库。

Research question was defined with PICOTS framework.

研究问题使用PICOTS框架进行了定义。

Pro- and retrospective clinical studies reporting BKPyV complications in adult kidney transplant recipients were included.

纳入了报告成人肾移植受者BKPyV并发症的前瞻性及回顾性临床研究。

Odds, hazard, or risk ratios were directly extracted or calculated.

直接提取或计算了比值、风险或危险比。

Endpoints were biopsy-proven-, presumptive BKPyVAN, BKPyV-DNAemia and events leading to treatment.

终点包括活检证实的、推测的BK病毒相关肾病(BKPyVAN)、BK病毒血症(BKPyV-DNAemia)以及导致治疗的事件。

Pooled risks were calculated with random effects models.

使用随机效应模型计算了合并风险。

Bias risks were assessed with QUIPS tools, funnel plots and I2 statistics.

使用QUIPS工具、漏斗图和I2统计量评估了偏倚风险。

Results

We identified 6,690 publications and included 165 encompassing 197,029 total patients.

我们筛选出6690篇出版物，并纳入了165篇，涵盖了总计197,029名患者。

Twenty-nine studies were graded as high risk for bias.

有29项研究被评估为高风险偏倚。

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).

纳入研究的数量以抗胸腺细胞球蛋白与IL-2RA的比较为最高（78项研究），他克莫司与环孢素的比较（54项研究），以及ABO不相容移植（32项研究）为次之。

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.

皮质类固醇与四个终点中的三个显著相关：他克莫司和抗胸腺细胞球蛋白有两个，他克莫司水平、ABO不相容移植、利妥昔单抗、吗替麦考酚酯、mTOR抑制剂和输尿管支架各有一个。

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.

我们无法识别出与所有终点相关的单一独立风险因素，这反映了预测肾移植受者BKPyV相关并发症的复杂性。

Rather than a single drug or procedure, insufficient net immune control over BKPyV replication in donor kidney may significantly promote BKPyV complications.

并非单一药物或程序，而是对供体肾脏中BKPyV复制的免疫控制不足，可能会显著促进BKPyV并发症。