Bonvoisin Catherine, Weekers Laurent, Xhignesse Patricia, Grosch Stéphanie, Milicevic Miroslav, Krzesinski Jean-Marie
Department of Nephrology and Renal Transplantation, University Hospitals Liege, Belgium.
Transplantation. 2008 Apr 15;85(7 Suppl):S42-8. doi: 10.1097/TP.0b013e318169c794.
Polyomavirus BK has emerged as an important complication after kidney transplantation. Although, BK nephropathy develops in only 1% to 5% of renal transplant recipients, its prognosis when present is very poor. The most accepted risk factor is the level of immunosuppressive treatment, but the serostatus of donor and recipient and the absence of human leukocyte antigen C7 in donor and/or recipient influence the BK virus (BKV) reactivation. The gold standard in diagnosing BKV nephropathy (BKVN) continues to be biopsy with use of immunohistochemistry for large T antigens. Urinary decoy cells and blood BKV DNA polymerase chain reaction are used in the screening, but their positive predictive values are poor. However, their use as predictors of the evolution of BKVN is more valuable. The reduction of immunosuppressive therapy currently represents the first-line treatment for BKVN. Cidofovir and leflunomide can be used when BKVN continues to progress. In the event of graft loss, retransplantation is possible with a low risk of recurrence when the infection is no longer active.
多瘤病毒BK已成为肾移植后一种重要的并发症。尽管只有1%至5%的肾移植受者会发生BK肾病，但其一旦出现，预后非常差。最公认的风险因素是免疫抑制治疗的水平，但供体和受体的血清状态以及供体和/或受体中缺乏人类白细胞抗原C7会影响BK病毒（BKV）的重新激活。诊断BKV肾病（BKVN）的金标准仍然是使用针对大T抗原的免疫组织化学进行活检。尿脱落细胞和血液BKV DNA聚合酶链反应用于筛查，但其阳性预测值较差。然而，它们作为BKVN病情发展预测指标的用途更有价值。目前减少免疫抑制治疗是BKVN的一线治疗方法。当BKVN持续进展时，可以使用西多福韦和来氟米特。如果移植肾丢失，当感染不再活跃时，再次移植复发风险较低。
