Park S B, Kwak J H, Lee K T, Hwang E A, Han S Y, Kim H T, Cho W H, Choi M S, Kim H C
Department of Internal Medicine, Keimyung University School of Medicine, 194 Dong San Dong, Daegu 700-712, Korea.
Transplant Proc. 2006 Sep;38(7):2059-61. doi: 10.1016/j.transproceed.2006.06.107.
Cytomegalovirus (CMV) and polyoma virus BK (BKV) may both establish latency following primary infection. Frequent reactivation of these viruses can occur in the kidney transplant recipients. BKV may induce CMV gene expression by stimulating cellular regulator proteins or by its own gene regulator proteins. A high rate of concurrent CMV infections has been noted in kidney transplant recipients with polyoma virus-associated nephropathy (PVAN).
PVAN was identified in 10 of 191 patients who received kidney transplants between October 1998 and September 2003. PVAN was confirmed by allograft kidney biopsy. Four of the 10 patients were complicated by concurrent CMV infection.
Two patients had only serological evidence of CMV infection and one patient had CMV gastritis. These three patients were treated with intravenous ganciclovir with good results. Disseminated ganciclovir-resistant CMV disease was demonstrated in the remaining patient. This 34-year-old kidney transplant recipient with PVAN died of multiorgan failure despite antiviral therapy with both ganciclovir and foscarnet.
PVAN with concurrent CMV infection in kidney transplant recipients showed variable clinical courses including mortality. Further studies are needed to elucidate the influence of PVAN on the pathogenesis of CMV infection.
巨细胞病毒（CMV）和多瘤病毒BK（BKV）在初次感染后均可建立潜伏状态。这些病毒在肾移植受者中可频繁再激活。BKV可通过刺激细胞调节蛋白或其自身的基因调节蛋白来诱导CMV基因表达。在患有多瘤病毒相关性肾病（PVAN）的肾移植受者中，已注意到CMV并发感染的高发生率。
在1998年10月至2003年9月期间接受肾移植的191例患者中，有10例被诊断为PVAN。PVAN通过移植肾活检得以确诊。10例患者中有4例并发CMV感染。
2例患者仅有CMV感染的血清学证据，1例患者患有CMV胃炎。这3例患者接受了静脉注射更昔洛韦治疗，效果良好。其余1例患者表现为播散性耐更昔洛韦CMV疾病。这位34岁患有PVAN的肾移植受者尽管接受了更昔洛韦和膦甲酸钠的抗病毒治疗，但仍死于多器官功能衰竭。
肾移植受者中PVAN并发CMV感染表现出包括死亡在内的不同临床病程。需要进一步研究以阐明PVAN对CMV感染发病机制的影响。
