Kim Hyun Chul, Hwang Eun Ah, Han Seung Yeup, Park Sung Bae, Park Kwan Kyu
Department of Internal Medicine, Dongsan Kidney Institute, Keimyung University, Dongsan Medical Center, Daegu, Korea.
Nephrology (Carlton). 2005 Apr;10(2):198-203. doi: 10.1111/j.1440-1797.2005.00393.x.
Polyomavirus associated nephropathy (PVN) in renal transplant recipients has been observed with increasing frequency recently and has emerged as a cause of allograft failure linked to highly potent new immunosuppressive regimens containing tacrolimus or mycophenolate mofetil (MMF).
Polyomavirus associated nephropathy was identified in nine out of 182 patients who received renal transplantation between October 1998 and July 2003. PVN was confirmed by allograft biopsy. The clinical records of these nine patients were reviewed, as were all of the allograft biopsies. Electron microscopy was performed in all nine cases. After the diagnosis of PVN, maintenance immunosuppression was reduced. The clinical course and outcome of the PVN patients were reviewed in relation to manipulation of immunosuppressive agents.
There were nine cases of PVN in renal transplant recipients and the incidence of PVN was 4.9%. All patients with PVN were under triple immunosuppression comprising tacrolimus and MMF. The mean time to a diagnosis of PVN was 7.8 months after transplantation. Three of the nine patients received antirejection therapy prior to PVN. Seven out of nine PVN patients presenting acute allograft dysfunction were initially treated with high-dose intravenous steroid pulse or OKT3 before reduction of the immunosuppression. After reduction of the immunosuppression, seven patients stabilized their renal function. Two (22%) lost their grafts due to persistent PVN and chronic rejection. Two (22%) patients later developed acute rejection after reduction of the immunosuppression.
PVN can cause allograft dysfunction and graft loss. Renal allograft recipients who are at risk of PVN should be routinely screened with urine cytology and quantitative measurements of viral load in the blood, particularly patients who had graft dysfunction. Early diagnosis and judicious alteration of immunosuppressive agents might permit a superior prognosis and reduce the graft loss from PVN in renal transplant recipients.
肾移植受者中的多瘤病毒相关性肾病（PVN）近来观察到的发病频率不断增加，并且已成为与含他克莫司或霉酚酸酯（MMF）的强效新型免疫抑制方案相关的移植肾失功的一个病因。
在1998年10月至2003年7月期间接受肾移植的182例患者中，有9例被诊断为多瘤病毒相关性肾病。PVN通过移植肾活检得以确诊。对这9例患者的临床记录以及所有移植肾活检标本进行了回顾。对所有9例病例均进行了电子显微镜检查。在诊断为PVN后，降低维持性免疫抑制治疗的强度。针对免疫抑制剂的调整，对PVN患者的临床病程及转归进行了回顾。
肾移植受者中有9例发生PVN，PVN的发生率为4.9%。所有PVN患者均接受包含他克莫司和MMF的三联免疫抑制治疗。诊断PVN的平均时间为移植后7.8个月。9例患者中有3例在发生PVN之前接受过抗排斥治疗。9例出现移植肾急性功能障碍的PVN患者中，有7例在降低免疫抑制强度之前最初接受了大剂量静脉类固醇冲击治疗或OKT3治疗。在降低免疫抑制强度后，7例患者的肾功能稳定。2例（22%）因持续性PVN和慢性排斥反应而移植肾失功。2例（22%）患者在降低免疫抑制强度后后来发生了急性排斥反应。
PVN可导致移植肾功能障碍和移植肾丢失。有PVN风险的肾移植受者应常规进行尿细胞学检查及血液中病毒载量的定量检测，尤其是那些有移植肾功能障碍的患者。早期诊断并合理调整免疫抑制剂可能会带来更好的预后，并减少肾移植受者中因PVN导致的移植肾丢失。
