Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Clin Transplant. 2011 Jul;25 Suppl 23:39-43. doi: 10.1111/j.1399-0012.2011.01479.x.
We present a case of severe BK polyomavirus nephropathy (BKVN) complicated with persistent acute T-cell-mediated rejection (ATMR) that progressed to allograft failure. A 54-yr-old man received a living donor kidney transplant from his wife. Approximately four months after transplantation, the patient's serum creatinine (SCr) increased from a baseline value of 1.5-2.4 mg/dL. A histological analysis showed BKVN, and the SV40 antigen was detected in the tubular nuclei. The doses of immunosuppressants were reduced, and immunoglobulin was administered intravenously. The SCr increased further, to 5.3 mg/dL, and a second renal biopsy revealed the presence of severe ATMR. Antirejection treatment was performed, and low-dose cidofovir was started. The SCr decreased, to 3 mg/dL, and BK virus antigen in the serum and urine samples became negative at the time of hospital discharge. However, the histological findings subsequently showed gradually progressive interstitial fibrosis and tubular atrophy, and the SCr increased gradually. Two years after the transplantation, the patient resumed hemodialysis. BK polyomavirus nephropathy is usually treated with a reduction in immunosuppressant therapy, although in some patients, the reduction in immunosuppressants induces a subsequent exacerbation of acute rejection and results in progressive graft failure, which suggests difficulty in treating BKVN after kidney transplantation.
我们报告了一例严重的 BK 多瘤病毒肾病（BKVN）合并持续性急性 T 细胞介导的排斥反应（ATMR）导致移植物衰竭的病例。一名 54 岁男性接受了来自其妻子的活体供肾移植。移植后约四个月，患者的血清肌酐（SCr）从基线值 1.5-2.4mg/dL 升高。组织学分析显示为 BKVN，并且在肾小管核中检测到 SV40 抗原。减少了免疫抑制剂的剂量，并静脉注射免疫球蛋白。SCr 进一步升高至 5.3mg/dL，第二次肾活检显示存在严重的 ATMR。进行了抗排斥治疗，并开始使用低剂量更昔洛韦。SCr 下降至 3mg/dL，出院时血清和尿液样本中的 BK 病毒抗原变为阴性。然而，随后的组织学发现逐渐出现进行性间质纤维化和肾小管萎缩，SCr 逐渐升高。移植后两年，患者恢复血液透析。BK 多瘤病毒肾病通常通过减少免疫抑制剂治疗来治疗，尽管在某些患者中，减少免疫抑制剂会诱发随后的急性排斥反应加重，并导致进行性移植物衰竭，这表明移植后治疗 BKVN 存在困难。
