Beimler Jörg, Sommerer Claudia, Zeier Martin
Nierenzentrum Heidelberg, Department of Nephrology/University of Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg.
Nephrol Dial Transplant. 2007 Sep;22 Suppl 8:viii66-viii71. doi: 10.1093/ndt/gfm646.
In the last decade the incidence of BK virus infection has increased in renal transplant recipients and become an important factor negatively influencing graft outcome. BK virus infection cannot be attributed to a single immunosuppressive agent or regimen. The risk of BKV infection is related to the overall load of immunosuppression, which is determined not only by immunosuppressive drugs but also by the humoral and cellular immunity of the recipient. Reduction in immunosuppression at this time appears to be the best available approach to the treatment of established BKVN. Assays are lacking that are able to measure the degree of immunosuppression in a given patient at a given time after transplantation. The balance between a sufficient yet nontoxic immunosuppressive regimen remains a major problem in preventing complications such as BK virus nephropathy. This article will focus on the influence of immunosuppressive medication on the development of BKVN. The role of other aspects such as viral virulence, humoral and cellular immunity or renal specificity will be shortly discussed.
在过去十年中，BK病毒感染在肾移植受者中的发生率有所上升，并成为对移植结果产生负面影响的重要因素。BK病毒感染不能归因于单一的免疫抑制剂或治疗方案。BKV感染的风险与免疫抑制的总体负荷有关，这不仅由免疫抑制药物决定，还由受者的体液免疫和细胞免疫决定。此时减少免疫抑制似乎是治疗已确诊的BK病毒肾病（BKVN）的最佳可用方法。目前缺乏能够在移植后特定时间测量特定患者免疫抑制程度的检测方法。在预防诸如BK病毒肾病等并发症方面，足够但无毒的免疫抑制方案之间的平衡仍然是一个主要问题。本文将重点关注免疫抑制药物对BKVN发生发展的影响。还将简要讨论其他方面的作用，如病毒毒力、体液免疫和细胞免疫或肾脏特异性。
