切换至 "中华医学电子期刊资源库"

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/OL]. 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/OL]. 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)
1
Mackenzie EF, Poulding JM, Harrison PR, et al. Human polyoma virus (HPV) - a significant pathogen in renal transplantation[J]. Proc Eur Dial Transplant Assoc, 1978,15:352-360.
2
Kean JM, Rao S, Wang M, et al. Seroepidemiology of human polyomaviruses[J]. PLoS Pathog, 2009,5(3):e1000363.
3
Xue JL, Ma JZ, Louis TA, et al. Forecast of the number of patients with end-stage renal disease in the United States to the year 2010[J]. J Am Soc Nephrol, 2001,12(12):2753-2758.
4
中华医学会器官移植学分会. 器官移植受者BK病毒感染和BK病毒性肾病临床诊疗规范(2019版)[J]. 器官移植,2019, 10(3): 237-242.
5
Ramos E, Drachenberg CB, Wali R, et al. The decade of polyomavirus BK-associated nephropathy: state of affairs[J]. Transplantation, 2009,87(5):621-630.
6
de Bruyn G, Limaye AP. BK virus-associated nephropathy in kidney transplant recipients[J]. Rev Med Virol, 2004,14(3):193-205.
7
Huang G, Chen LZ, Qiu J, et al. Prospective study of polyomavirus BK replication and nephropathy in renal transplant recipients in China: a single center analysis of incidence, reduction in immunosuppression and clinical course[J]. Clin Transplant, 2010,24(5):599-609.
8
Zakaria ZE, Elokely AM, Ghorab AA, et al. Screening for BK viremia/viruria and the impact of management of BK virus nephropathy in renal transplant recipients[J]. Exp Clin Transplant, 2019,17(Suppl 1):83-91.
9
Mallon DH, Summers DM, Bradley JA, et al. Defining delayed graft function after renal transplantation: simplest is best[J]. Transplantation, 2013,96(10):885-889.
10
Hirsch HH, Knowles W, Dickenmann M, et al. Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients[J]. N Engl J Med, 2002,347(7):488-496.
11
Nickeleit V, Singh HK, Randhawa P, et al. The Banff Working Group classification of definitive polyomavirus nephropathy: morphologic definitions and clinical correlations[J]. J Am Soc Nephrol, 2018,29(2):680-693.
12
范宇,石炳毅,钱叶勇,等. 尿液与血液病毒载量在肾移植受者BK病毒性肾病诊断中的应用[J]. 中华器官移植杂志,2013,34(10):595-599.
13
Stervbo U, Nienen M, Weist BJD, et al. BKV clearance time correlates with exhaustion state and T-cell receptor repertoire shape of BKV-specific T-cells in renal transplant patients[J]. Front Immunol, 2019,10:767.
14
Devresse A, Tinel C, Vermorel A, et al. No clinical benefit of rapid versus gradual tapering of immunosuppression to treat sustained BK virus viremia after kidney transplantation:a single-center experience[J]. Transpl Int, 2019,32(5):481-492.
15
Loupy A, Lefaucheur C, Vernerey D, et al. Complement-binding anti-HLA antibodies and kidney-allograft survival[J]. N Engl J Med, 2013,369(13):1215-1226.
16
Sood P, Senanayake S, Sujeet K, et al. Management and outcome of BK viremia in renal transplant recipients: a prospective single-center study[J]. Transplantation, 2012,94(8):814-821.
17
Everly MJ, Rebellato LM, Haisch CE, et al. Incidence and impact of de novo donor-specific alloantibody in primary renal allografts[J]. Transplantation, 2013,95(3):410-417.
18
Gatault P, Kamar N, Büchler M, et al. Reduction of extended-release tacrolimus dose in low-immunological-risk kidney transplant recipients increases risk of rejection and appearance of donor-specific antibodies: A randomized study[J]. Am J Transplant, 2017,17(5):1370-1379.
19
Hardinger KL, Koch MJ, Bohl DJ, et al. BK-virus and the impact of pre-emptive immunosuppression reduction: 5-year results[J]. Am J Transplant, 2010, 10(2):407-415.
20
Santeusanio AD, Lukens BE, Eun J, et al. Antiviral treatment of BK virus viremia after kidney transplantation[J]. Am J Health Syst Pharm, 2017,74(24):2037-2045.
21
Yuan X, Chen C, Zheng Y, et al. Conversion from mycophenolates to mizoribine is associated with lower BK virus load in kidney transplant recipients: A prospective study[J]. Transplant Proc, 2018,50(10):3356-3360.
22
Shiraki K, Ishibashi M, Okuno T, et al. Effects of cyclosporine, azathioprine, mizoribine, and prednisolone on replication of human cytomegalovirus[J]. Transplant Proc, 1990,22(4):1682-1685.
[1] 中华医学会器官移植学分会. 遗体捐献肾脏获取手术技术操作指南[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 257-265.
[2] 邹永康, 石雍, 徐贤刚, 张帅民, 刘衍, 杨生鹏, 叶啟发, 陈根, 张毅. 肾移植术后手术切口米根霉感染伴菌血症一例并文献复习[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 289-292.
[3] 吕玥彤, 靳梦圆, 周大为, 叶啟发. 机器人辅助下肾移植的临床进展与争议[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 242-246.
[4] 尚丽红, 王志华, 张文艳, 朱琳茹, 周华. 内皮粘蛋白抗体与肾移植术后抗体介导排斥反应和移植肾预后的研究[J/OL]. 中华移植杂志(电子版), 2024, 18(03): 165-170.
[5] 吕军好, 林锦雯, 张心怡, 陈江华. 细胞外囊泡在肾移植诊断和治疗中的研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(03): 186-192.
[6] 陆婷, 陈浩, 王雪静, 谭若芸, 彭宇竹. 肾移植术后一年发生代谢综合征的危险因素分析[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 98-103.
[7] 郭明星, 徐烨, 徐菀佚, 赵莹, 刘冉佳, 潘晨, 崔向丽. 2017—2022年中国105家医院肾移植术后门诊受者免疫抑制剂用药分析[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 104-109.
[8] 张心怡, 吕军好, 陈大进. 2023年肾移植领域研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 7-11.
[9] 吴小山, 任桂灵, 朱杰东, 史天陆, 马葵芬. 肾移植受者围手术期霉酚酸暴露量及不良反应分析[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 17-21.
[10] 赵丽, 蔡瑞明, 赵纪强, 林民专, 陈志勇, 彭娟. 肾移植术后新发泌尿系统恶性肿瘤二例并文献复习[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 35-39.
[11] 陆婷, 姜巧玲, 孙黎, 王雪静. 加速康复外科在肾移植围手术期应用的研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 55-59.
[12] 李晓宇, 许昕, 谌诚, 张萌, 韩文科, 林健. 肾移植受者新型冠状病毒感染合并肺炎支原体感染临床特点及诊疗分析[J/OL]. 中华移植杂志(电子版), 2023, 17(06): 354-357.
[13] 刘路浩, 张鹏, 陈荣鑫, 郭予和, 尹威, 徐璐, 李光辉, 方佳丽, 马俊杰, 陈正. 奈玛特韦/利托那韦治疗肾移植术后重型新型冠状病毒肺炎的临床效果分析[J/OL]. 中华移植杂志(电子版), 2023, 17(06): 349-353.
[14] 彭文翰. 肾移植受者早期霉酚酸强化剂量长期有效性和安全性的研究[J/OL]. 中华移植杂志(电子版), 2023, 17(05): 0-0.
[15] 张秋玥, 程羽, 牛雨田, 唐茂芝, 张克勤, 张懿, 郭亚楠, 涂增. 肾移植与人体微生态的相关性研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(02): 207-213.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?