Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Transpl Int. 2012 Jun;25(6):687-95. doi: 10.1111/j.1432-2277.2012.01480.x. Epub 2012 Apr 18.
The present study investigated the clinical usefulness of plasma real-time polymerase chain reaction (PCR) (plasma-PCR) in the prevention of BK virus-associated nephropathy (BKVAN). First, we investigated the diagnostic value of plasma BK-PCR, urine BK-PCR, and urine cytology for the prediction of BKVAN retrospectively. Then we designed a prospective study of regular plasma-PCR monitoring and pre-emptive immunosuppression (IS) reduction based on the result. In the retrospective cohort, the prevalence of BKVAN was 3.7% (14/379) and the positive rate of decoy cells, urine-PCR (>1 × 10(10) copies/ml), and plasma-PCR (>1 × 10(4) copies/ml) was 18.6%, 11.1%, and 5.5%, respectively. Plasma-PCR was superior to urine-PCR or urine cytology in specificity and positive predictive value for detection of BKVAN. In prospective study, regular monitoring of plasma-PCR detected significant BKV viremia in 8.3% (12/145) and BKVAN in 1 patient (0.6%). After IS reduction, BKV viremia was eliminated in 91.6% (11/12) within 103 days (25-254). In patients with viremia, the frequency of acute rejection did not increase and allograft function did not differ significantly compared with those in patients without viremia during the first year post-transplant (P > 0.05, in both). Plasma-PCR is useful to predict an increased risk for BKVAN, and regular monitoring is effective to prevent the development of BKVAN.
本研究旨在探讨血浆实时聚合酶链反应（PCR）（血浆-PCR）在预防 BK 病毒相关性肾病（BKVAN）中的临床应用。首先，我们回顾性地研究了血浆 BK-PCR、尿 BK-PCR 和尿细胞学对 BKVAN 的预测价值。然后，我们根据结果设计了一项定期监测血浆-PCR 和抢先减少免疫抑制（IS）的前瞻性研究。在回顾性队列中，BKVAN 的患病率为 3.7%（14/379），空泡细胞、尿-PCR（>1×10(10)拷贝/ml）和血浆-PCR（>1×10(4)拷贝/ml）的阳性率分别为 18.6%、11.1%和 5.5%。与尿-PCR 或尿细胞学相比，血浆-PCR 在特异性和阳性预测值方面对 BKVAN 的检测更具优势。在前瞻性研究中，定期监测血浆-PCR 检测到 8.3%（12/145）的患者出现显著的 BKV 病毒血症和 1 例（0.6%）的 BKVAN。在减少 IS 后，11/12 例患者的 BKV 病毒血症在 103 天（25-254 天）内消除。在病毒血症患者中，与无病毒血症患者相比，急性排斥反应的频率并没有增加，移植物功能在移植后第一年也没有显著差异（P>0.05，均）。血浆-PCR 有助于预测 BKVAN 风险增加，定期监测可有效预防 BKVAN 的发生。
