Alagoz Selma, Kuskucu Mert, Gulcicek Sibel, Yalin Serkan Feyyaz, Oruc Meric, Midilli Kenan, Yılmaz Erkan, Altiparmak Mehmet Riza, Seyahi Nurhan
1 Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
2 Department of Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Prog Transplant. 2017 Jun;27(2):152-159. doi: 10.1177/1526924817699969. Epub 2017 Mar 27.
BK virus (BKV) nephropathy has increasingly become an important cause of morbidity in renal transplant recipients. We evaluated the frequency and associated factors for BKV infection in a center performing mainly living donor transplantations over a long time period.
One hundred consecutive renal transplant patients were included. Quarterly visits were planned to examine urine for decoy cells and to measure the BKV DNA in the blood and urine. Renal biopsy was performed in case of deteriorated allograft function. Serological examinations for BKV immunoglobulin G (IgG) were performed in donors.
Throughout the entire follow-up period, the rates of viruria, viremia, and the positivity of decoy cells were 12%, 6%, and 13%, respectively. The negative and positive predictive values of decoy cells were 93.1% and 69.2%, respectively, for viruria, and 99.2% and 45.5%, respectively, for viremia. Biopsy-proven BKV nephropathy was observed in 1 patient. The BKV IgG was positive in all living donors. Viruria and viremia were associated with deceased donor transplantation, acute rejection, and pulse steroid therapy. In addition, viremia was associated with antithymocyte globulin therapy and a short duration of the posttransplant period.
The frequency of BKV infection was lower in our transplant unit compared to previous reports. Reduced doses of immunosuppression seem to be the main factor that may explain the reduced frequency. However, an active screening strategy is still of importance for this patient group.
BK病毒（BKV）肾病日益成为肾移植受者发病的重要原因。我们评估了在一个长期主要进行活体供肾移植的中心中BKV感染的频率及相关因素。
纳入连续的100例肾移植患者。计划每季度进行访视，检查尿液中的诱饵细胞，并检测血液和尿液中的BKV DNA。在移植肾功能恶化时进行肾活检。对供者进行BKV免疫球蛋白G（IgG）的血清学检查。
在整个随访期间，病毒尿、病毒血症和诱饵细胞阳性率分别为12%、6%和13%。诱饵细胞对病毒尿的阴性和阳性预测值分别为93.1%和69.2%，对病毒血症的阴性和阳性预测值分别为99.2%和45.5%。1例患者经活检证实为BKV肾病。所有活体供者的BKV IgG均为阳性。病毒尿和病毒血症与 deceased 供者移植、急性排斥反应和脉冲类固醇治疗有关。此外，病毒血症与抗胸腺细胞球蛋白治疗及移植后较短的时间有关。
与以往报道相比，我们移植单位中BKV感染的频率较低。免疫抑制剂量的减少似乎是解释频率降低的主要因素。然而，积极的筛查策略对该患者群体仍然很重要。
