Wadei H M, Rule A D, Lewin M, Mahale A S, Khamash H A, Schwab T R, Gloor J M, Textor S C, Fidler M E, Lager D J, Larson T S, Stegall M D, Cosio F G, Griffin M D
Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Am J Transplant. 2006 May;6(5 Pt 1):1025-32. doi: 10.1111/j.1600-6143.2006.01296.x.
Polyomavirus-associated nephropathy (PVAN) is managed by reduced immunosuppression with or without antiviral therapy. Data from 55 patients with biopsy-proven PVAN were analyzed for adverse outcomes and influence of baseline variables and interventions. During 20+/-11 months follow-up, the frequencies of graft loss, major and any functional decline were 15%, 24% and 38%, respectively. Repeat biopsies were performed in 45 patients with persistent PVAN in 47%. Low-dose cidofovir, IVIG and cyclosporine conversion were used in 55%, 20% and 55% of patients. No single intervention was associated with improved outcome. Of the variables examined, only degree of interstitial fibrosis at diagnosis was associated with kidney function decline. In contrast, donor source, interstitial fibrosis, proportion of BKV positive tubules and plasma viral load at diagnosis were all associated with failure of histological viral clearance. This retrospective, nonrandomized analysis suggests that: (i) Graft loss within 2 years of PVAN diagnosis is now uncommon, but ongoing functional decline and persistent infection occur frequently. (ii) Low-dose cidofovir, IVIG and conversion to cyclosporine do not abrogate adverse outcomes following diagnosis. (iii) Fibrosis at the time of diagnosis predicts subsequent functional decline. Further elucidation of the natural history of PVAN and its response to individual interventions will require prospective clinical trials.
多瘤病毒相关性肾病（PVAN）通过减少免疫抑制（无论是否联合抗病毒治疗）来进行管理。对55例经活检证实为PVAN的患者的数据进行分析，以了解不良结局以及基线变量和干预措施的影响。在20±11个月的随访期间，移植肾丢失、严重功能衰退和任何功能衰退的发生率分别为15%、24%和38%。47%的45例持续性PVAN患者进行了重复活检。55%、20%和55%的患者分别使用了低剂量西多福韦、静脉注射免疫球蛋白（IVIG）和环孢素转换。没有单一干预措施与改善结局相关。在所检查的变量中，只有诊断时的间质纤维化程度与肾功能衰退相关。相比之下，供体来源、间质纤维化、诊断时BK病毒阳性肾小管的比例和血浆病毒载量均与组织学病毒清除失败相关。这项回顾性、非随机分析表明：（i）PVAN诊断后2年内移植肾丢失现在并不常见，但持续的功能衰退和持续性感染频繁发生。（ii）低剂量西多福韦、IVIG和转换为环孢素并不能消除诊断后的不良结局。（iii）诊断时的纤维化可预测随后的功能衰退。进一步阐明PVAN的自然史及其对个体干预的反应将需要前瞻性临床试验。
