Simard-Meilleur Marie-Christine, Bodson-Clermont Paule, St-Louis Gilles, Pâquet Michel R, Girardin Catherine, Fortin Marie-Chantal, Cardinal Héloïse, Hébert Marie-Josée, Lévesque Renée, Renoult Edith
Département de Médecine, Service de Néphrologie, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Transpl Infect Dis. 2017 Jun;19(3). doi: 10.1111/tid.12681. Epub 2017 Apr 17.
BK polyomavirus virus (BKPyV) screening and immunosuppression reduction effectively prevent graft loss due to BKPyV-associated nephropathy (BKPVAN) during the first year after transplantation. The aim of our study was to evaluate the impact of this infection during longer follow-up periods.
We reviewed the outcome of our screening and immunosuppression reduction protocol in 305 patients who received a kidney transplant between March 2008 and January 2013. Quantitative BKPyV DNA surveillance in plasma was performed at 1, 2, 3, 6, 9, and 12 months after transplantation. Patients with significant viremia and/or biopsy-proven BKPVAN were treated with immunosuppression reduction and leflunomide.
During the first post-transplant year, 24 patients (7.9%) developed significant viremia at a median time of 95 days, and 18 patients had BKPVAN; 23 of the 24 (7.5%) were treated according to our protocol (group BKV+); 225 patients (73.8%) did not develop any BK viremia (group BKV-). Allograft function was similar in both groups at 1 month post transplantation (P=.87), but significantly worse at 1 year in the BKV+ group (P=.002). Thereafter, kidney function stabilized in the BKV+ group and no differences in patient and graft survival were seen between the groups after a median follow-up of 4 years.
We confirm the early occurrence of BKPyV replication after transplantation and the short-term decline in renal function. However, early detection of BKPyV replication, prompt diagnosis, and reduction in immunosuppression may offer long-term benefits for graft function.
BK多瘤病毒（BKPyV）筛查及降低免疫抑制可有效预防移植后第一年因BK多瘤病毒相关性肾病（BKPVAN）导致的移植物丢失。我们研究的目的是评估在更长随访期内这种感染的影响。
我们回顾了2008年3月至2013年1月期间接受肾移植的305例患者的筛查及降低免疫抑制方案的结果。在移植后1、2、3、6、9和12个月进行血浆中BKPyV DNA定量监测。对有显著病毒血症和/或活检证实为BKPVAN的患者进行降低免疫抑制及来氟米特治疗。
在移植后的第一年，24例患者（7.9%）在中位时间95天时出现显著病毒血症，18例患者患有BKPVAN；24例中的23例（7.5%）按照我们的方案进行了治疗（BKV+组）；225例患者（73.8%）未出现任何BK病毒血症（BKV-组）。两组在移植后1个月时的移植肾功能相似（P = 0.87），但在1年时BKV+组明显更差（P = 0.002）。此后，BKV+组的肾功能稳定，在中位随访4年后，两组之间的患者及移植物存活率未见差异。
我们证实了移植后BKPyV复制的早期发生及肾功能的短期下降。然而，早期检测BKPyV复制、及时诊断及降低免疫抑制可能对移植肾功能有长期益处。
