肾移植后JC多瘤病毒再激活的动态预测

Dynamic prediction of JC polyomavirus reactivation after kidney transplantation

摘要

目的 构建肾移植术后JC多瘤病毒（JCV）再激活动态预测模型。方法 回顾性分析2021年6月至2024年12月于南方医科大学南方医院接受肾移植且符合研究标准的128例受者临床资料。采用基于界标法的动态Cox回归和动态限制性平均生存时间（RMST）回归构建动态预测模型，并通过蒙特卡洛交叉验证评估模型性能。结果 动态模型可根据移植后第1个月至第6个月各界标时间点的协变量预测未来3个月内JCV再激活的发生率和发生时间。Remuzzi评分、体重指数和热缺血时间为JCV再激活的风险因素，尿BK多瘤病毒再激活史为保护因素。动态Cox模型的曲线下面积、C指数和Brier评分的中位数分别为0.873、0.851和0.065，而动态RMST模型的C指数为0.829，均优于静态模型。结论 基于界标法的动态模型预测性能高，可整合基线和术后随访资料实现对JCV再激活风险和时间窗的动态评估，为优化术后监测与个体化干预策略提供依据。

Abstract

Objective To construct a dynamic prediction model for JC polyomavirus (JCV) reactivation after kidney transplantation. Methods A retrospective analysis was conducted on the clinical data of 128 recipients who met the inclusion criteria and received kidney transplantation in Nanfang Hospital, Southern Medical University, from June 2021 to December 2024. Dynamic Cox regression and dynamic restricted mean survival time (RMST) regression based on the landmark method were adopted to establish the dynamic prediction models, and Monte Carlo cross-validation was used to evaluate model performance. Results The dynamic models could predict the incidence and onset time of JCV reactivation within the subsequent 3 months according to covariates at each landmark time point from the 1st to the 6th month after transplantation. Remuzzi score, body mass index and warm ischemia time were independent risk factors for JCV reactivation, while a history of urinary BK polyomavirus reactivation served as a protective factor. The median values of the area under the curve, C-index and Brier score of the dynamic Cox model were 0.873, 0.851 and 0.065 respectively, and the C-index of the dynamic RMST model was 0.829, all of which were superior to those of the static model. Conclusions The landmark-based dynamic models exhibit excellent predictive performance, which may integrate baseline data and post-transplant follow-up information to realize dynamic assessment of the risk and time window of JCV reactivation, thereby providing evidence for optimizing post-operative monitoring and individualized intervention strategies.

关键词

JC多瘤病毒 / 再激活 / 肾移植 / 动态模型 / 限制性平均生存时间回归

Key words

JC polyomavirus / Reactivation / Kidney transplantation / Dynamic model / Restricted mean survival time regression

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基金资助

国家自然科学基金(82070770)

国家自然科学基金(82270784)

国家自然科学基金(82500920)

国家自然科学基金(82473723)

广东省基础与应用基础研究基金(2024A1515012700)

广东省基础与应用基础研究基金(2024A1515011402)

广州地区临床高新和重大技术建设项目(2024CL-GX03)

南方医科大学南方医院临床研究专项(2024CR005)

大学生创新创业训练计划项目(202412121046)