Jinling Hospital, National Clinical Research Center of Kidney Diseases, Medical School of Nanjing University, 305 East Zhong Shan Road, 210002, Nanjing, China.
BMC Nephrol. 2021 Oct 2;22(1):328. doi: 10.1186/s12882-021-02527-3.
Some studies have suggested mizoribine (MZR) could inhibit the replication of BK polyomavirus (BKPyV). The purpose of this study was to explore whether conversion from mycophenolate mofetil (MMF) to MZR in the early stages of BKPyV infection can improve kidney allograft prognosis.
Twenty-one kidney transplant recipients with BKPyV viruria/viremia and ten with BK polyomavirus-associated allograft nephropathy (BKPyVAN) received MZR conversion therapy were retrospectively identified. The clearance rate of urine and blood BKPyV DNA, change of serum creatinine (SCr), uric acid (UA), hemoglobin (HB), white blood cell (WBC), lymphocyte ratio, platelet (PLT), routine urinalysis, panel reactive antibody (PRA), and gastrointestinal disorders during follow-up of the 2 groups were evaluated and compared.
After MZR conversion therapy, the clearance rate of urine and blood viral load in BKPyV viruria/viremia group were 85.7 and 100 %, while that in BKPyVAN were 40 and 87.5 %, respectively. Stable SCr were observed in all cases of BKPyV viruria/viremia group, while that of BKPyVAN was only 40 % (P < 0.001) and one even progressed to end-stage renal disease. The results of routine urinalysis in the two groups showed no significant changes before and after MZR conversion therapy. However, in BKPyV viruria/viremia group, four cases developed acute rejection and one had positive PRA-II but no donor specific antibody, requiring conversion back to MMF. Hyperuricemia was the common adverse effect of MZR.
Conversion from MMF to MZR could help clear BKPyV infection. As compared to BKPyVAN, patients who underwent initiation of MZR conversion therapy in the early stages of BKPyV infection maintained stable allograft function. Prospective studies with larger sample size are needed to ascertain this preliminary finding.
一些研究表明，霉酚酸酯（MMF）可抑制 BK 多瘤病毒（BKPyV）的复制。本研究旨在探讨 BKPyV 感染早期由 MMF 转换为米佐膦酸酯（MZR）是否能改善肾移植预后。
回顾性分析 21 例 BKPyV 尿病毒血症/血病毒血症和 10 例 BK 多瘤病毒相关性移植肾肾病（BKPyVAN）患者接受 MZR 转换治疗的情况。比较两组患者尿和血 BKPyV DNA 清除率、血清肌酐（SCr）、尿酸（UA）、血红蛋白（HB）、白细胞（WBC）、淋巴细胞比值、血小板（PLT）、常规尿分析、群体反应性抗体（PRA）及胃肠道反应的变化。
MZR 转换治疗后，BKPyV 尿病毒血症/血病毒血症组患者尿和血病毒载量清除率分别为 85.7%和 100%，BKPyVAN 组分别为 40%和 87.5%。BKPyV 尿病毒血症/血病毒血症组所有患者 SCr 均稳定，而 BKPyVAN 组仅 40%（P<0.001），1 例甚至进展至终末期肾病。两组患者 MZR 转换治疗前后常规尿分析结果无明显变化。但在 BKPyV 尿病毒血症/血病毒血症组，4 例发生急性排斥反应，1 例 PRA-II 阳性但无供体特异性抗体，需要转换回 MMF。MZR 的常见不良反应是高尿酸血症。
由 MMF 转换为 MZR 有助于清除 BKPyV 感染。与 BKPyVAN 相比，在 BKPyV 感染早期开始 MZR 转换治疗的患者保持了稳定的移植肾功能。需要更大样本量的前瞻性研究来证实这一初步发现。
