Naumnik B, Kowalewska J, Zalewski G, Charkiewicz R, Myśliwiec M
Department of Nephrology and Transplantation with Dialysis Unit, Medical University, Bialystok, Poland.
Transplant Proc. 2011 Oct;43(8):2976-84. doi: 10.1016/j.transproceed.2011.07.009.
BK polyomavirus (BKV) infection and BKV-associated nephropathy (BKVAN) are among the most important problems in renal transplantation. We aimed to determine the incidence of BK viruria, viremia, and BKVAN in renal transplant recipients in the northeastern part of Poland.
Urine and blood samples from 126 cadaveric renal transplant recipients were analyzed for BK viruria and viremia using quantitative real-time polymerase chain reaction and the patients were followed prospectively. The diagnosis of BKVAN was established on the allograft biopsy.
Based on the BKV DNA analysis, the patients were divided into three groups: group 1 (n=89; 70.6%) without viruria or viremia, group 2 (n=24; 19.1%) with isolated viruria, and group 3 (n=13; 10.3%) with both viruria and viremia. The presence of BK viremia negatively correlated with time after the transplantation. BK viruria was associated with mycophenolate mofetil daily dose. In group 3 there were four patients (3.2%) with high viremia (>10(4) genome equivalents [gEq]/mL) and viruria (>10(7) gEq/mL) loads. Only one patient from this group developed clinical symptoms and had BKVAN in allograft biopsy. In all four cases, the maintenance immunosuppression therapy was based on tacrolimus and steroids.
Prevalence of BKV infection in renal transplant recipients in the northeastern part of Poland is similar to that reported by studies from other countries. We confirm that BK viremia could be predicted by the presence of intense viruria. Time after transplantation and the type of immunosuppression strategy are the most important predictors of BK viremia and viruria in patients after renal transplantation.
BK多瘤病毒（BKV）感染及BKV相关性肾病（BKVAN）是肾移植中最重要的问题之一。我们旨在确定波兰东北部肾移植受者中BK病毒尿症、病毒血症及BKVAN的发生率。
采用定量实时聚合酶链反应对126例尸体肾移植受者的尿液和血液样本进行BK病毒尿症和病毒血症分析，并对患者进行前瞻性随访。BKVAN的诊断基于移植肾活检。
根据BKV DNA分析，患者被分为三组：第1组（n = 89；70.6%）无病毒尿症或病毒血症；第2组（n = 24；19.1%）仅有病毒尿症；第3组（n = 13；10.3%）既有病毒尿症又有病毒血症。BK病毒血症的存在与移植后的时间呈负相关。BK病毒尿症与霉酚酸酯的每日剂量有关。第3组中有4例患者（3.2%）病毒血症水平高（>10⁴基因组当量[gEq]/mL）且病毒尿症水平高（>10⁷ gEq/mL）。该组中只有1例患者出现临床症状，移植肾活检显示患有BKVAN。在所有4例病例中，维持免疫抑制治疗均基于他克莫司和类固醇。
波兰东北部肾移植受者中BKV感染的患病率与其他国家研究报告的相似。我们证实，强烈的病毒尿症可预测BK病毒血症。移植后的时间和免疫抑制策略类型是肾移植患者BK病毒血症和病毒尿症的最重要预测因素。
