Mitterhofer A P, Tinti F, Umbro I, Pietropaolo V, Fiacco F, Bellizzi A, Anzivino E, Ginanni Corradini S, Poli L, Rossi M, Berloco P B, Ferretti G, Chiarini F, Taliani G
Department of Clinical Medicine, Nephrology and Dialysis Unit, 1st Faculty of Medicine and Surgery, Sapienza University of Rome, Rome, Italy.
Transplant Proc. 2012 Sep;44(7):1934-7. doi: 10.1016/j.transproceed.2012.06.052.
End-stage liver disease (ESLD) and chronic kidney disease (CKD) patients are both immunocompromised populations but polyomavirus BK (BKV) replication before liver transplantation is rare. We evaluated BKV prevalence among liver transplant recipients with renal dysfunction and the possible role of CKD as a risk factor for BKV replication in ESLD. From 2010 to 2011 we selected 31 ESLD patients awaiting liver transplantation to identify, the presence of CKD: No CKD (n = 22; 18 males) and CKD group (n = 9; 5 males). BKV infection was defined on the basis of viremia evaluated using quantitative real-time polymerase chain reactions. The prevalence of viremia among the No CKD group was 14% versus 56% in the CKD group (Fisher test; P = .027). We hypothesized that the presence of CKD may represent an additional condition of immunologic dysfunction regarding antiviral surveillances other than the antibacterial one that characterizes ESLD immunodysfunction, which could have promoted BKV replication. The specific immunologic mechanisms involved in pretransplantation diseases may have a role in BKV reactivation that could become responsible for nephropathy after transplantation.
终末期肝病（ESLD）患者和慢性肾脏病（CKD）患者均为免疫功能低下人群，但肝移植前多瘤病毒BK（BKV）复制罕见。我们评估了肾功能不全的肝移植受者中BKV的流行情况，以及CKD作为ESLD中BKV复制危险因素的可能作用。2010年至2011年，我们选择了31例等待肝移植的ESLD患者，以确定是否存在CKD：无CKD组（n = 22；18例男性）和CKD组（n = 9；5例男性）。BKV感染根据使用定量实时聚合酶链反应评估的病毒血症来定义。无CKD组的病毒血症患病率为14%，而CKD组为56%（Fisher检验；P = 0.027）。我们推测，CKD的存在可能代表了除ESLD免疫功能障碍所特有的抗菌监测外的抗病毒监测方面的另一种免疫功能障碍情况，这可能促进了BKV复制。移植前疾病所涉及的特定免疫机制可能在BKV重新激活中起作用，而BKV重新激活可能导致移植后肾病。
