Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2013 Dec;28(12):1711-5. doi: 10.3346/jkms.2013.28.12.1711. Epub 2013 Nov 26.
BK virus-associated nephropathy (BKVAN) is one of the major causes of allograft dysfunction in kidney transplant (KT) patients. We compared BKVAN combined with acute rejection (BKVAN/AR) with BKVAN alone in KT patients. We retrospectively analyzed biopsy-proven BKVAN in KT patients from 2000 to 2011 at Seoul National University Hospital. Among 414 biopsies from 951 patients, biopsy-proven BKVAN was found in 14 patients. Nine patients had BKVAN alone, while 5 patients had both BKVAN and acute cellular rejection. BKVAN in the BKVAN alone group was detected later than in BKVAN/AR group (21.77 vs 6.39 months after transplantation, P=0.03). Serum creatinine at diagnosis was similar (2.09 vs 2.00 mg/dL). Histological grade was more advanced in the BKVAN/AR group (P=0.034). Serum load of BKV, dose of immunosuppressants, and tacrolimus level showed a higher tendency in the BKVAN alone group; however it was not statistically significant. After anti-rejection therapy, immunosuppression was reduced in the BKVAN/AR group. Renal functional deterioration over 1 yr after BKVAN diagnosis was similar between the two groups (P=0.665). These findings suggest that the prognosis of BKVAN/AR after anti-rejection therapy followed by anti-BKV therapy might be similar to that of BKVAN alone after anti-BKV therapy.
BK 病毒相关性肾病（BKVAN）是导致肾移植（KT）患者移植物功能障碍的主要原因之一。我们比较了合并急性排斥反应（BKVAN/AR）与单纯 BKVAN 的 KT 患者。我们回顾性分析了 2000 年至 2011 年在首尔国立大学医院接受活检证实的 BKVAN 的 KT 患者。在 951 例患者的 414 次活检中，发现 14 例患者有活检证实的 BKVAN。9 例患者单纯 BKVAN，5 例患者同时合并急性细胞排斥反应。单纯 BKVAN 组的 BKVAN 检测时间晚于 BKVAN/AR 组（移植后 21.77 个月 vs. 6.39 个月，P=0.03）。诊断时的血清肌酐相似（2.09 vs. 2.00 mg/dL）。BKVAN/AR 组的组织学分级更严重（P=0.034）。BKV 血清负荷、免疫抑制剂剂量和他克莫司水平在单纯 BKVAN 组中呈升高趋势，但无统计学意义。抗排斥治疗后，BKVAN/AR 组减少免疫抑制。BKVAN 诊断后 1 年内肾功能恶化在两组间相似（P=0.665）。这些发现表明，在抗 BKV 治疗后进行抗排斥治疗，然后进行抗 BKV 治疗，BKVAN/AR 的预后可能与单纯 BKVAN 治疗后相似。
