Transplantation Virology, Institute for Medical Microbiology, Department of Biomedicine, University of Basel Internal Medicine, University Hospital of Basel, Switzerland.
Am J Transplant. 2010 Oct;10(10):2324-30. doi: 10.1111/j.1600-6143.2010.03265.x. Epub 2010 Sep 14.
Polyomavirus-associated nephropathy (PyVAN) is rare in nonrenal solid organ transplantation and only limited information is available from single cases. We describe a 67-year-old female presenting with hypertension and progressive kidney failure due to PyVAN 60 months after lung transplantation. Plasma BK virus (BKV) loads were 4.85 log¹⁰ copies/mL at diagnosis and cleared slowly over 14 months after switching from tacrolimus, mycophenolate and prednisone to low-dose tacrolimus, sirolimus and leflunomide, the latter being discontinued for anemia and diarrhea. BKV- and JC virus-specific immunoglobulins were detectable prior to transplantation. Only BKV-specific IgG and IgM increased during follow-up. BKV-specific T cells were detectable in blood following in vitro expansion, but cleared with reincreased sirolimus, yet BKV viremia remained undetectable. We identified eight other cases of PyVAN in nonrenal solid organ transplantation including lung (n = 1), heart (n = 6) and pancreas (n = 1). Overall, diagnosis was later than commonly seen in kidney transplants (median 18 months, interquartile range 10-29). Seven patients were male, five received triple immunosuppression consisting of tacrolimus, mycophenolate, prednisone. Immunosuppression was reduced in four cases and cidofovir and/or leflunomide administered in five and two cases, respectively. Renal function deteriorated in five requiring hemodialysis in four. We discuss mTOR inhibitors versus cidofovir and leflunomide as potential PyVAN rescue therapy.
多瘤病毒相关性肾病（PyVAN）在非肾实体器官移植中较为罕见，且仅有有限的个案报道。我们报道了一例 67 岁女性，在肺移植后 60 个月因 PyVAN 出现高血压和进行性肾衰竭。诊断时血浆 BK 病毒（BKV）载量为 4.85log¹⁰ 拷贝/ml，在将他克莫司、霉酚酸酯和泼尼松转换为低剂量他克莫司、西罗莫司和来氟米特后，病毒载量在 14 个月内缓慢清除，后者因贫血和腹泻而停用。移植前可检测到 BKV 和 JC 病毒特异性免疫球蛋白。仅在随访期间 BKV 特异性 IgG 和 IgM 增加。在体外扩增后可检测到 BKV 特异性 T 细胞，但在西罗莫司重新增加时清除，然而 BKV 血症仍无法检测到。我们在非肾实体器官移植中发现了另外 8 例 PyVAN，包括肺（n=1）、心脏（n=6）和胰腺（n=1）。总体而言，诊断时间晚于肾移植中常见的时间（中位数为 18 个月，四分位距为 10-29）。7 名患者为男性，5 名患者接受了由他克莫司、霉酚酸酯、泼尼松组成的三联免疫抑制治疗。4 例患者减少了免疫抑制，5 例和 2 例患者分别给予更昔洛韦和/或来氟米特。5 例患者的肾功能恶化，4 例需要血液透析。我们讨论了 mTOR 抑制剂与更昔洛韦和来氟米特作为潜在的 PyVAN 挽救治疗的选择。
