Pham Phuong-Thu, Schaenman Joanna, Pham Phuong-Chi
aDepartment of Medicine, Nephrology Division, David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles bDepartment of Medicine, Division of Infectious Disease, David Geffen School of Medicine at UCLA, Los Angeles cDepartment of Medicine, Division of Nephrology and Hypertension, Olive View-UCLA Medical Center, Sylmar, California, USA.
Curr Opin Organ Transplant. 2014 Aug;19(4):401-12. doi: 10.1097/MOT.0000000000000101.
In recipients of kidney transplants, the emergence of BK virus (BKV)-associated clinical syndromes, such as viruria, viremia, and BK nephropathy, coincided with the advent of potent immunosuppressive therapy. There is currently no standardized protocol for the management of BK viruria or viremia, or established BK nephropathy. Suggested risk factors for BKV replication and a literature overview on various treatment strategies for BKV-associated clinical syndromes are presented, followed by the authors' proposed approach for screening, monitoring, and treatment of post-transplant BKV infection.
BKV infection can occur under all combinations of immunosuppressive therapy. Although both humoral and cellular immunity may be essential, BKV-specific T-cell immunity appears to play a pivotal role in controlling BKV replication. Monitoring BKV-specific immune response might prove useful in guiding therapeutic intervention. The beneficial effects of antiviral agents remain unclear. Development of T-cell or antibody-based vaccines against BKV is a subject of future research.
In the absence of conclusive evidence that any particular immunosuppressive agent has a specific influence over another on BKV infection risk and the unclear benefit of antiviral agents, intensive monitoring of serum BKV using PCR and immunological containment of BKV replication should remain the mainstay of therapy. The routine recommendations of antiviral agents in the treatment of BKV-associated clinical syndromes await results of large prospective randomized trials.
在肾移植受者中，BK病毒（BKV）相关临床综合征（如病毒尿症、病毒血症和BK肾病）的出现与强效免疫抑制治疗的问世同时发生。目前尚无针对BK病毒尿症或病毒血症以及已确诊的BK肾病的标准化管理方案。本文介绍了BKV复制的潜在危险因素以及关于BKV相关临床综合征各种治疗策略的文献综述，随后是作者提出的肾移植后BKV感染的筛查、监测和治疗方法。
BKV感染可在免疫抑制治疗的所有组合情况下发生。虽然体液免疫和细胞免疫可能都很重要，但BKV特异性T细胞免疫似乎在控制BKV复制中起关键作用。监测BKV特异性免疫反应可能有助于指导治疗干预。抗病毒药物的有益效果仍不明确。开发针对BKV的T细胞或抗体疫苗是未来研究的一个课题。
在缺乏确凿证据表明任何特定免疫抑制剂对BKV感染风险有特定影响且抗病毒药物益处不明确的情况下，使用PCR对血清BKV进行强化监测以及对BKV复制进行免疫控制仍应是治疗的主要手段。在治疗BKV相关临床综合征时常规推荐使用抗病毒药物尚需大型前瞻性随机试验的结果。
