Polyomavirus in renal transplantation: A hot problem
Polyomavirus in renal transplantation: A hot problem
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DOI：
10.1097/tp.0b013e318169c794
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发表时间：
2008-04-15
期刊：
影响因子：
6.2
通讯作者：
Krzesinski, Jean-Marie
中科院分区：
文献类型：
--
作者：
Bonvoisin, Catherine;Weekers, Laurent;Krzesinski, Jean-Marie
多瘤病毒 BK 已成为肾移植后的重要并发症。尽管仅 1% 至 5% 的肾移植受者会出现 BK 肾病，但其预后非常差。最常见的危险因素是免疫抑制治疗的水平，但供体和受体的血清状态以及供体和/或受体中人类白细胞抗原 C7 的缺乏会影响 13K 病毒 (BKV) 的重新激活。诊断 BKV 肾病 (BKVN) 的金标准仍然是使用免疫组织化学检测大 T 抗原进行活检。尿液诱饵细胞和血液BKV DNA聚合酶链反应用于筛查，但其阳性预测值较差。然而，将它们用作 BKVN 进化的预测因子更有价值。目前，减少免疫抑制治疗是 BKVN 的一线治疗方法。当 BKVN 继续进展时，可以使用西多福韦和来氟米特。如果移植物丢失，当感染不再活跃时，再次移植是可能的，复发的风险较低。
Polyomavirus BK has emerged as an important complication after kidney transplantation. Although, BK nephropathy develops in only 1 % to 5% of renal transplant recipients, its prognosis when present is very poor. The most accepted risk factor is the level of inummosuppressive treatment, but the serostatus of donor and recipient and the absence of human leukocyte antigen C7 in donor and/or recipient influence the 13K virus (BKV) reactivation. The gold standard in diagnosing BKV nephropathy (BKVN) continues to be biopsy with use of immunohistochemistry for large T antigens. Urinary decoy cells and blood BKV DNA polymerase chain reaction are used in the screening, but their positive predictive values are poor. However, their use as predictors of the evolution of BKVN is more valuable. The reduction of immunosuppressive therapy currently represents the first-line treatment for BKVN. Cidofovir and leflunomide can be used when BKVN continues to progress. In the event of graft loss, retransplantation is possible with a low risk of recurrence when the infection is no longer active.