Trofe J, Gaber L W, Stratta R J, Shokouh-Amiri M H, Vera S R, Alloway R R, Lo A, Gaber A O, Egidi M F
Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, USA.
Transpl Infect Dis. 2003 Mar;5(1):21-8. doi: 10.1034/j.1399-3062.2003.00009.x.
To report the incidence and clinical characteristics of polyomavirus (PV) nephritis in kidney (KTX) and kidney-pancreas transplant (KPTX) recipients.
Single center retrospective analysis of all cases of PV nephritis in KTX and KPTX patients transplanted between 1994 and 1999.
Thirteen (5 KTX and 8 KPTX) patients (2.1%) had PV nephritis diagnosed on multiple biopsies (n = 22) among 504 KTX and 106 KPTX recipients. The incidence of PV nephritis was higher in cadaver donor transplants (2.6% cadaver vs. 0.7% living donors), after KPTX (1% KTX vs. 7.5% KPTX), in males (3.3% male vs. 0.7% female), and in diabetic patients (4.4% diabetic vs. 0.8% nondiabetic). The mean time to diagnosis of PV nephritis was 18 (range 6-48) months after KTX and 17 (range 9-31) months after KPTX. Three KTX patients and 5 KPTX patients had calcineurin inhibitor toxicity on biopsy prior to developing PV nephritis. Reduction in immunosuppression occurred in 100% of KTX and 63% of KPTX patients. Three patients (23%) developed rejection within 3 months of diagnosis of PV, 1 after a reduction in immunosuppression. Despite multiple antiviral treatment regimens, renal allograft failure requiring dialysis occurred in 60% of KTX and 50% of KPTX patients. All KPTX patients remain insulin independent and 2 were successfully retransplanted with living donor kidneys. 2 patients (15%) died but there was no mortality directly related to the virus.
Polyomavirus nephritis may be increasing in incidence and appears to be unresponsive to either conventional antiviral agents or a reduction in immunosuppression. Most of our cases occurred in male diabetic patients undergoing cadaveric donor transplantation and were preceded by biopsy-proven nephrotoxicity. Further studies are needed to better define the pathogenesis of PV and effective antiviral treatment.
报告肾移植（KTX）和肾胰联合移植（KPTX）受者中多瘤病毒（PV）肾炎的发病率及临床特征。
对1994年至1999年间接受移植的KTX和KPTX患者中所有PV肾炎病例进行单中心回顾性分析。
在504例KTX受者和106例KPTX受者中，13例（5例KTX和8例KPTX）患者（2.1%）经多次活检（n = 22）确诊为PV肾炎。PV肾炎在尸体供肾移植中的发病率更高（尸体供肾为2.6%，活体供肾为0.7%），在KPTX后（KTX为1%，KPTX为7.5%），男性（男性为3.3%，女性为0.7%）以及糖尿病患者（糖尿病患者为4.4%，非糖尿病患者为0.8%）中发病率更高。PV肾炎的平均诊断时间在KTX后为18个月（范围6 - 48个月），在KPTX后为17个月（范围9 - 31个月）。3例KTX患者和5例KPTX患者在发生PV肾炎之前活检显示有钙调神经磷酸酶抑制剂毒性。100%的KTX患者和63%的KPTX患者减少了免疫抑制。3例患者（23%）在诊断PV后3个月内发生排斥反应，1例在免疫抑制减少后发生。尽管采用了多种抗病毒治疗方案，但60%的KTX患者和50%的KPTX患者出现了需要透析的移植肾失功。所有KPTX患者仍无需胰岛素治疗，2例成功接受了活体供肾再次移植。2例患者（感15%）死亡，但无直接与病毒相关的死亡病例。
多瘤病毒肾炎的发病率可能在上升，并且似乎对传统抗病毒药物或免疫抑制的减少均无反应。我们的大多数病例发生在接受尸体供肾移植的男性糖尿病患者中，且之前经活检证实存在肾毒性。需要进一步研究以更好地明确PV的发病机制和有效的抗病毒治疗方法。
