Ramos Emilio, Vincenti Flavio, Lu Wei X, Shapiro Ron, Trofe Jennifer, Stratta Robert J, Jonsson Johann, Randhawa Parmjeet S, Drachenberg Cinthia B, Papadimitriou John C, Weir Matthew R, Wali Ravinder K
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Transplantation. 2004 Jan 15;77(1):131-3. doi: 10.1097/01.TP.0000095898.40458.68.
The characteristics and outcome in 10 patients who underwent retransplantation after losing their renal grafts to BK virus-associated nephropathy (BKAN) are described. The patients underwent retransplantation at a mean of 13.3 months after failure of the first graft. Nephroureterectomy of the first graft was performed in seven patients. Maintenance immunosuppression regimens after the first and second grafts were similar, consisting of a combination of a calcineurin inhibitor, mycophenolate mofetil, and prednisone. BKAN recurred in one patient 8 months after retransplantation, but stabilization of graft function was achieved with a decrease in immunosuppression and treatment with low-dose cidofovir. After a mean follow-up of 34.6 months, all patients were found to have good graft function with a mean creatinine of 1.5 mg/dL. From this collective experience from five transplant centers (although the follow-up after retransplantation was not extensive), it can be concluded that patients with graft loss caused by BKAN can safely undergo retransplantation. The risk of recurrence does not seem to be increased in comparison with the first graft.
本文描述了10例因BK病毒相关性肾病（BKAN）导致肾移植失败后接受再次移植患者的特征及预后。这些患者在首次移植失败后平均13.3个月接受了再次移植。7例患者进行了首次移植肾的肾输尿管切除术。首次和第二次移植后的维持免疫抑制方案相似，包括钙调神经磷酸酶抑制剂、霉酚酸酯和泼尼松联合使用。1例患者在再次移植后8个月BKAN复发，但通过减少免疫抑制和低剂量西多福韦治疗实现了移植肾功能的稳定。平均随访34.6个月后，发现所有患者移植肾功能良好，平均肌酐水平为1.5mg/dL。从五个移植中心的这一总体经验（尽管再次移植后的随访并不广泛）可以得出结论，因BKAN导致移植失败的患者可以安全地接受再次移植。与首次移植相比，复发风险似乎并未增加。
