Polyoma virus-associated nephropathy and concurrent cytomegalovirus infection in the kidney transplant recipients
Polyoma virus-associated nephropathy and concurrent cytomegalovirus infection in the kidney transplant recipients
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DOI：
10.1016/j.transproceed.2006.06.107
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发表时间：
2006-09-01
影响因子：
0.9
通讯作者：
Kim, H. C.
中科院分区：
文献类型：
--
作者：
Park, S. B.;Kwak, J. H.;Kim, H. C.
导论.巨细胞病毒（CMV）和多瘤病毒BK（BKV）均可在初次感染后潜伏。这些病毒的频繁再活化可发生在肾移植受者中。BKV可通过刺激细胞调节蛋白或通过其自身的基因调节蛋白诱导CMV基因表达。肾移植受者多瘤病毒相关性肾病（PVAN）合并巨细胞病毒感染的发生率较高。在1998年10月至2003年9月期间接受肾移植的191名患者中，有10名患者被确定为PVAN。移植肾活检证实PVAN。10例患者中4例合并CMV感染。2例患者仅存在CMV感染的血清学证据，1例患者存在CMV胃炎。这3例患者均采用静脉注射更昔洛韦治疗，效果良好。在其余患者中证实了播散性更昔洛韦耐药CMV疾病。这位34岁的肾移植患者尽管接受了更昔洛韦和膦甲酸的抗病毒治疗，但仍死于多器官功能衰竭。肾移植受者的PVAN并发CMV感染表现出不同的临床病程，包括死亡率。PVAN对CMV感染发病机制的影响有待进一步研究。
Introduction. Cytomegalovirus (CMV) and polyoma virus BK (BKV) may both establish latency following primary infection. Frequent reactivation of these viruses can occur in the kidney transplant recipients. BKV may induce CMV gene expression by stimulating cellular regulator proteins or by its own gene regulator proteins. A high rate of concurrent CMV infections has been noted in kidney transplant recipients with polyoma virus-associated nephropathy (PVAN).Methods. PVAN was identified in 10 of 191 patients who received kidney transplants between October 1998 and September 2003. PVAN was confirmed by allograft kidney biopsy. Four of the 10 patients were complicated by concurrent CMV infection.Results. Two patients had only serological evidence of CMV infection and one patient had CMV gastritis. These three patients were treated with intravenous ganciclovir with good results. Disseminated ganciclovir-resistant CMV disease was demonstrated in the remaining patient. This 34-year-old kidney transplant recipient with PVAN died of multiorgan failure despite antiviral therapy with both ganciclovir and foscarnet.Conclusion. PVAN with concurrent CMV infection in kidney transplant recipients showed variable clinical courses including mortality. Further studies are needed to elucidate the influence of PVAN on the pathogenesis of CMV infection.