Barzon Luisa, Murer Luisa, Pacenti Monia, Biasolo Maria Angela, Della Vella Manuela, Benetti Elisa, Zanon Giovanni Franco, Palù Giorgio
Department of Histology, Microbiology, and Medical Biotechnologies, University of Padova, Padova, Italy.
J Infect Dis. 2009 Feb 1;199(3):372-80. doi: 10.1086/596053.
The relevance of viral infections in the development of allograft lesions is still unclear, although some viruses have been implicated. The present study investigated systemic and intrarenal viral infections in kidney transplant recipients and their association with the risk of acute rejection and chronic allograft injuries that are predictive of long-term dysfunction.
The presence of DNA sequences of human herpesviruses, polyomaviruses, and parvovirus B19 was analyzed in renal allograft biopsy specimens obtained at baseline, after acute renal dysfunction, and during follow-up evaluation in 69 transplant recipients who were children or young adults. Results were correlated with clinical data, viral DNAemia, and results of renal function tests and allograft histology analyzed at the same time points.
Overall, viral DNA was detectable in 46% of baseline and 70% of follow-up biopsy specimens of kidney allografts, where it generally persisted. The most frequently detected viruses were B19 and human herpesvirus 6, already present in donor kidneys, and BK virus and Epstein-Barr virus, usually involving the allograft during follow-up. Among viruses, only the intrarenal persistence of B19 DNA and B19 DNAemia was associated with the development of chronic allograft injury, whereas human cytomegalovirus DNAemia was a risk factor for acute rejection.
Parvovirus B19 seems to target the kidney electively. Its intrarenal persistence is associated with chronic kidney allograft injury.
尽管一些病毒已被认为与移植病变的发生有关，但病毒感染在同种异体移植病变发展中的相关性仍不明确。本研究调查了肾移植受者的全身和肾内病毒感染情况，以及它们与急性排斥反应风险和慢性移植损伤（可预测长期功能障碍）的关联。
对69名儿童或年轻成人肾移植受者在基线、急性肾功能障碍后及随访评估时获取的肾移植活检标本，分析人疱疹病毒、多瘤病毒和细小病毒B19的DNA序列。将结果与同时期的临床数据、病毒血症及肾功能测试和移植肾组织学结果进行关联分析。
总体而言，在46%的肾移植基线活检标本和70%的随访活检标本中可检测到病毒DNA，且病毒通常持续存在。最常检测到的病毒是已存在于供肾中的B19和人疱疹病毒6，以及通常在随访期间累及移植肾的BK病毒和EB病毒。在这些病毒中，只有B19 DNA在肾内的持续存在及B19病毒血症与慢性移植损伤的发生有关，而人巨细胞病毒血症是急性排斥反应的一个危险因素。
细小病毒B19似乎选择性地靶向肾脏。其在肾内的持续存在与慢性肾移植损伤有关。
