Namba Yukiomi, Moriyama Toshiki, Kyo Masahiro, Imamura Ryoichi, Shi Yi, Ichimaru Naotsugu, Oka Kazumasa, Takahara Shiro, Okuyama Akihiko
Department of Urology Graduate School of Medicine, Osaka University, Osaka, Japan.
Clin Transplant. 2005 Feb;19(1):97-101. doi: 10.1111/j.1399-0012.2004.00305.x.
BK virus nephropathy (BKN) is recognized as a cause of graft loss in renal transplant patients. This may be related to the introduction of new and potent immunosuppressive regimens. In Japan, our experience regarding its prevalence, clinical significance, and outcome is still limited. In this study, our primary purpose is to outline the prevalence, outcome, and clinical characteristics of BKN as observed at Osaka University Hospital.
We retrospectively analyzed 112 biopsy specimens from 87 renal transplant patients. All transplantations were from living donors. Of the 112 biopsy specimens, 71 were from protocol biopsies and 41 were from episode biopsies. Calcineurin inhibitors and corticosteroid were used in all patients (tacrolimus 32 and cyclosporin 55). In addition, azathioprine was used in 43 patients, mizoribine was used in 24 patients, and mycophenolate mofetil was used in 20 patients. BKN was diagnosed by light microscopic examination and a positive immunohistochemical staining of anti-SV40 antibody in a biopsy specimen. In order to investigate the outcome and potential risk factors of patients with different histological staging, we divided the patients into groups A (mild histological change) and B (moderate or severe histological change).
Of the 87 patients, six were diagnosed with BKN. There were no significant differences between BKN patients and non-BKN patients, except for the number of patients with graft loss (p < 0.001). Of the six BKN patients, three were in group A, and three were in group B. We recognized a significant difference between group A and group B in terms of anti-rejection treatment including glucocorticoid, tacrolimus trough levels of over 8 ng/mL, episode of acute rejection within 1-month post-transplantation, and the time period between transplantation and BKN diagnosis.
This is the first report of BKN in Japanese renal allograft recipients. In our hospital, the prevalence, risk factors, and outcome were similar to those previously for non-Japanese recipients.
BK病毒肾病（BKN）被认为是肾移植患者移植肾丢失的一个原因。这可能与新的强效免疫抑制方案的应用有关。在日本，我们关于其患病率、临床意义及预后的经验仍然有限。在本研究中，我们的主要目的是概述大阪大学医院观察到的BKN的患病率、预后及临床特征。
我们回顾性分析了87例肾移植患者的112份活检标本。所有移植均来自活体供者。在这112份活检标本中，71份来自方案活检，41份来自事件活检。所有患者均使用钙调神经磷酸酶抑制剂和糖皮质激素（他克莫司32例，环孢素55例）。此外，43例患者使用硫唑嘌呤，24例患者使用咪唑立宾，20例患者使用霉酚酸酯。通过活检标本的光镜检查及抗SV40抗体免疫组化染色阳性诊断BKN。为了研究不同组织学分期患者的预后及潜在危险因素，我们将患者分为A组（轻度组织学改变）和B组（中度或重度组织学改变）。
87例患者中，6例被诊断为BKN。除移植肾丢失患者数量外，BKN患者与非BKN患者之间无显著差异（p<0.001）。6例BKN患者中，3例在A组，3例在B组。我们发现A组和B组在抗排斥治疗（包括糖皮质激素）、他克莫司谷浓度超过8 ng/mL、移植后1个月内急性排斥事件以及移植与BKN诊断之间的时间段方面存在显著差异。
这是日本肾移植受者中BKN的首次报告。在我院，其患病率、危险因素及预后与之前非日本受者的情况相似。
Zotero 插件