Centre de Néphrologie et Transplantation Rénale, APHM, CHU Conception, Marseille, France.
Rev Med Virol. 2013 Jan;23(1):50-69. doi: 10.1002/rmv.1732. Epub 2012 Nov 7.
Viruses are the most important cause of infections and a major source of mortality in Kidney Transplant Recipients (KTRs). These patients may acquire viral infections through exogenous routes including community exposure, donor organs, and blood products or by endogenous reactivation of latent viruses. Beside major opportunistic infections due to CMV and EBV and viral hepatitis B and C, several viral diseases have recently emerged in KTRs. New medical practices or technologies, implementation of new diagnostic tools, and improved medical information have contributed to the emergence of these viral diseases in this special population. The purpose of this review is to summarize the current knowledge on emerging viral diseases and newly discovered viruses in KTRs over the last two decades. We identified viruses in the field of KT that had shown the greatest increase in numbers of citations in the NCBI PubMed database. BKV was the most cited in the literature and linked to an emerging disease that represents a great clinical concern in KTRs. HHV-8, PVB19, WNV, JCV, H1N1 influenza virus A, HEV, and GB virus were the main other emerging viruses. Excluding HHV8, newly discovered viruses have been infrequently linked to clinical diseases in KTRs. Nonetheless, pathogenicity can emerge long after the discovery of the causative agent, as has been the case for BKV. Overall, antiviral treatments are very limited, and reducing immunosuppressive therapy remains the cornerstone of management.
病毒是导致感染和肾移植受者(KTR)死亡的主要原因。这些患者可能通过外源性途径(包括社区暴露、供体器官和血液制品)或内源性潜伏病毒的重新激活而获得病毒感染。除了巨细胞病毒(CMV)和 EBV 以及乙型和丙型病毒性肝炎等主要机会性感染外,KTR 中最近还出现了几种病毒性疾病。新的医疗实践或技术、新诊断工具的实施以及更好的医疗信息促成了这些病毒疾病在这一特殊人群中的出现。本文旨在总结过去二十年中 KTR 中新兴病毒疾病和新发现病毒的最新知识。我们在 NCBI PubMed 数据库中确定了 KT 领域中病毒数量增加最多的病毒。BK 病毒在文献中被引用最多,与一种新兴疾病有关,该疾病在 KTR 中具有重要的临床意义。HHV-8、PVB19、WNV、JCV、甲型流感病毒 H1N1、戊型肝炎病毒和庚型肝炎病毒是主要的其他新兴病毒。除了 HHV8,新发现的病毒很少与 KTR 中的临床疾病有关。尽管如此,病原体的致病性可能在发现后的很长时间内才会显现,就像 BK 病毒一样。总体而言,抗病毒治疗非常有限,减少免疫抑制治疗仍然是管理的基石。