Wu Sheng-Wen, Chang Horng-Rong, Lian Jong-Da
Division of Nephrology, Chung Shan Medical University Hospital, Taichung, Taiwan.
Nephrol Dial Transplant. 2009 Mar;24(3):1034-8. doi: 10.1093/ndt/gfn675. Epub 2008 Dec 4.
Polyomavirus-associated nephropathy (PVAN) has an unfavourable impact on graft survival. The cornerstone of therapy is early reduction of immunosuppressive medications; however, the rate of graft failure is still high. Antiviral drugs, such as cidofovir, are thought to have therapeutic effects, but the benefits of cidofovir in retarding the deterioration of PVAN are still a controversial issue.
Fourteen renal kidney recipients were diagnosed to have biopsy-proven PVAN between 2001 and 2006 in Chung-Shan Medical University Center with nearly 600 renal transplant recipients. After the diagnosis of PVAN, all patients were treated with a reduction of their original immunosuppressive medications with/without converting tacrolimus to cyclosporine. Eight of the 14 patients agreed to receive low-dose cidofovir (0.5 mg/kg) every 2 weeks for a total of six doses.
During 30 +/- 18 months of follow-up, three (37%) patients in the cidofovir-treated and three (50%) patients in the non-cidofovir-treated group experienced graft loss (P = 0.64). The rejection rate before PVAN diagnosis or other baseline characteristics of the patients between two groups were not significantly different. The long-term survival rate to graft loss and major graft functional decline with Kaplan-Meier analysis between the two groups were not significantly different (P = 0.898 and P = 0.243). In all demographic and clinical characteristics, we found that there was a tendency towards long-term major graft functional decline in the patients with acute rejection prior to PVAN diagnosis (P = 0.04).
We concluded that (1) there was no obvious effect of low-dose cidofovir on long-term graft survival in patients with PVAN, and (2) acute rejection prior to PVAN diagnosis was a potential risk factor for poorer long-term graft outcome.
多瘤病毒相关性肾病（PVAN）对移植肾存活有不利影响。治疗的关键是早期减少免疫抑制药物用量；然而，移植肾失败率仍然很高。抗病毒药物如西多福韦被认为具有治疗作用，但西多福韦在延缓PVAN病情恶化方面的益处仍是一个有争议的问题。
2001年至2006年期间，在中山医学大学中心近600例肾移植受者中，14例肾移植受者经活检证实患有PVAN。PVAN诊断后，所有患者均接受减少原免疫抑制药物用量的治疗，部分患者将他克莫司转换为环孢素。14例患者中有8例同意每2周接受一次低剂量西多福韦（0.5mg/kg）治疗，共6剂。
在30±18个月的随访期间，西多福韦治疗组有3例（37%）患者移植肾丢失，未接受西多福韦治疗组有3例（50%）患者移植肾丢失（P=0.64）。两组患者PVAN诊断前的排斥反应率或其他基线特征无显著差异。两组间采用Kaplan-Meier分析的移植肾丢失长期生存率和主要移植肾功能下降率无显著差异（P=0.898和P=0.243）。在所有人口统计学和临床特征中，我们发现PVAN诊断前发生急性排斥反应的患者存在长期主要移植肾功能下降的趋势（P=0.04）。
我们得出结论：（1）低剂量西多福韦对PVAN患者的长期移植肾存活无明显影响；（2）PVAN诊断前的急性排斥反应是长期移植肾预后较差的潜在危险因素。
