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中华移植杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 81 -85. doi: 10.3877/cma.j.issn.1674-3903.2021.02.004

论著

肾移植术后BK病毒感染诊疗单中心研究
刘德川1, 周洪澜1, 王钢1, 刘俊彦1, 朱亚香1, 于迪1, 王金国1,()   
  1. 1. 长春 130000,吉林大学第一医院泌尿外二科
  • 收稿日期:2020-09-26 出版日期:2021-04-25
  • 通信作者: 王金国

A single-center retrospective analysis of the occurrence and outcome of BK virus infection after renal transplantation

Dechuan Liu1, Honglan Zhou1, Gang Wang1, Junyan Liu1, Yaxiang Zhu1, Di Yu1, Jinguo Wang1,()   

  1. 1. The Second Department of Urology, the First Hospital of Jilin University, Changchun 130000, China
  • Received:2020-09-26 Published:2021-04-25
  • Corresponding author: Jinguo Wang
引用本文:

刘德川, 周洪澜, 王钢, 刘俊彦, 朱亚香, 于迪, 王金国. 肾移植术后BK病毒感染诊疗单中心研究[J]. 中华移植杂志(电子版), 2021, 15(02): 81-85.

Dechuan Liu, Honglan Zhou, Gang Wang, Junyan Liu, Yaxiang Zhu, Di Yu, Jinguo Wang. A single-center retrospective analysis of the occurrence and outcome of BK virus infection after renal transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2021, 15(02): 81-85.

目的

总结肾移植受者BK病毒(BKV)感染各阶段发生情况、治疗和预后。

方法

回顾性分析2015年12月至2018年12月在吉林大学第一医院接受肾移植手术并规律随访监测BKV感染的肾移植受者临床资料,观察BKV感染各阶段发生率及治疗效果和转归情况。

结果

截至2019年6月,629例肾移植受者中位随访时间为16个月。BKV尿症发生率为24.5%(154/629),检出时间为术后(5.3±5.0)个月;BKV血症发生率为7.5%(47/629),检出时间为术后(8.2±7.4)个月;BK病毒性肾病(BKVN)发生率为4.3%(27/629),检出时间为术后(14.5±8.4)个月,移植肾失功发生率为1.9%(12/629)。肾移植术后12个月内是BKV感染的高发期。154例肾移植术后BKV尿症受者中,30例低水平BKV尿症受者采取严密随访监测方案,124例高水平BKV尿症受者采取免疫抑制剂快速减量方案;35.7%(55/154)尿液BKV DNA载量降至低水平,23.4%(36/154)尿液BKV转阴,24.7%(38/154)尿液BKV DNA载量仍持续高水平,8.4%(13/154)进展为BKV血症,7.8%(12/154)进展为BKVN,未发生移植肾失功。47例肾移植术后BKV血症受者中,44例采取免疫抑制剂转换方案,3例采取免疫抑制剂快速减量方案;55.3%(26/47)血清BKV转阴,31.9%(15/47)进展为BKVN,12.8%(6/47)血清BKV持续阳性。27例肾移植术后BKVN受者全部采取免疫抑制剂转换+抗病毒治疗方案;63.0%(17/27)血清BKV转阴,22.2%(6/27)血清BKV持续阳性,均出现移植肾功能异常,14.8%(4/27)出现移植肾失功。

结论

肾移植术后1年内是BKV感染高发期,在此期间规律筛查BKV,对及早发现感染并采取抢先治疗意义重大。

Objective

To summarize the incidence, treatment and prognosis of BK virus (BKV) infection in renal transplant recipients.

Methods

The clinical data of recipients who underwent renal transplantation in the First Hospital of Jilin University from December 2015 to December 2018 and were regularly followed up and monitored for BKV infection were retrospectively analyzed to observe the incidence of each stage of BKV infection and the therapeutic effect and outcome.

Results

As of June 2019, the median follow-up time of 629 renal transplant recipients was 16 months. The incidence of BK viruria was 24.5% (154/629), and the detection time was (5.3±5.0) months after surgery; the incidence of BK viremia was 7.5% (47/629), and the detection time was (8.2±7.4) months after surgery; the incidence of BK virus nephropathy (BKVN) was 4.3% (27/629), the detection time was (14.5±8.4) months after surgery, and the incidence of renal allograft failure was 1.9% (12/629). The incidence of BKV infection is high within 12 months after renal transplantation. Among the 154 recipients with BK viruria after renal transplantation, 30 recipients with low-level BK viruria were treated with a close follow-up monitoring regimen, and 124 recipients with high-level BKV urination were treated with a rapid dose reduction regimen of immunosuppressive agents; 35.7% (55/154) had a decrease in urine BKV DNA load to a low level, 23.4% (36/154) had a negative urine BKV, 24.7% (38/154) had a persistently high urine BKV DNA load, 8.4% (13/154) progressed to BK viremia, 7.8% (12/154) progressed to BKVN, and no renal allograft failure occurred. Among the 47 recipients with BK viremia after renal transplantation, 44 were treated with immunosuppressant conversion regimen and 3 with immunosuppressant rapid dose reduction regimen; 55.3% (26/47) had negative serum BKV, 31.9% (15/47) progressed to BKVN, and 12.8% (6/47) had persistently positive serum BKV. All 27 BKVN recipients after renal transplantation were treated with immunosuppressant conversion+ antiviral treatment therapy; 63.0% (17/27) had negative serum BKV, 22.2% (6/27) had persistently positive serum BKV, all had abnormal renal allograft function, and 14.8% (4/27) had renal allograft failure.

Conclusions

The incidence of BKV infection is high at 1-year after renal transplantation. Regular screening of BKV during this period is of great significance for early detection of infection and preemptive treatment.

图1 肾移植术后BKV感染各阶段发生率随术后时间变化情况
表1 BKV感染各阶段治疗方案及临床转归(例)
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