检测、治疗骨髓灰质炎 B19 感染引起的实体器官移植后贫血：194 例患者的病例系列和文献复习。

The detection, treatment of parvovirus B19 infection induced anemia in solid organ transplants: A case series and literature review of 194 patients.

机构信息

Urology Department, Urology research institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Department of Transplantation Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.

出版信息

Transfus Clin Biol. 2022 May;29(2):168-174. doi: 10.1016/j.tracli.2021.12.005. Epub 2022 Jan 8.

DOI:10.1016/j.tracli.2021.12.005

PMID:35007720

Abstract

BACKGROUND

There are no optimal diagnostic, treatment and post-infection surveillance strategies for parvovirus B19 infection in solid organ transplantation (SOT) recipients.

METHODS

We conducted a retrospective review of all PVB19 infected cases confirmed by qPCR among SOT recipients at our institution over a 3-year period and reviewed the literature from 1990 to 2021.

RESULTS

Eight kidney and two heart transplant patients with refractory anemia had PVB19 infection. The viral DNA load in peripheral blood ranged from 2.62×10 to 8.31×10 copies/mL. Two patients with the lowest PVB19 DNA load only reduced the use of immunosuppressants and anemia was relieved. Eight received intravenous immunoglobulin (IVIG) (ranging from 0.25 to 0.5g/kg/day). The median time to anemia improvement (hemoglobulin>100g/L) was 16days (8-70days) after treatment. One patient had a PVB19 relapse and viral DNA load>1.00×10 copies/mL at diagnosis. A total of 86 studies involving 194 SOTs were screened from the literature, and the most common symptom was anemia and low reticulocyte count. PVB19 DNA was detected in all cases. Of that, 91.4% of cases received IVIG, 53.8% received IVIG and immunosuppression reduction, 6.5% of cases showed reduced immunosuppression without IVIG, and 2.1% did not receive any special treatment. The recurrence rate was 17.5%.

CONCLUSION

PVB19 infection is a cause of anemia after SOT, and treatment mainly relies on IVIG and/or immunosuppression reduction.

摘要

背景

目前尚无针对实体器官移植（SOT）受者细小病毒 B19 感染的最佳诊断、治疗和感染后监测策略。

方法

我们对本机构 3 年内通过 qPCR 确认的所有 PVB19 感染病例进行了回顾性分析，并对 1990 年至 2021 年的文献进行了回顾。

结果

8 例肾移植和 2 例心脏移植患者出现难治性贫血，外周血病毒 DNA 载量为 2.62×10 至 8.31×10 拷贝/ml。2 例病毒 DNA 载量最低的患者仅减少了免疫抑制剂的使用，贫血得到缓解。8 例患者接受了静脉注射免疫球蛋白（IVIG）（0.25 至 0.5g/kg/天）。治疗后贫血改善（血红蛋白>100g/L）的中位时间为 16 天（8-70 天）。1 例患者在诊断时出现 PVB19 复发和病毒 DNA 载量>1.00×10 拷贝/ml。从文献中筛选出了 86 项共涉及 194 例 SOT 的研究，最常见的症状是贫血和低网织红细胞计数。所有病例均检测到 PVB19 DNA。其中，91.4%的患者接受 IVIG 治疗，53.8%的患者接受 IVIG 和免疫抑制减少治疗，6.5%的患者接受单纯免疫抑制减少治疗，2.1%的患者未接受任何特殊治疗。复发率为 17.5%。