Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany.
Viruses. 2022 May 9;14(5):1005. doi: 10.3390/v14051005.
Balancing the immune system with immunosuppressive treatment is essential in kidney transplant recipients to avoid allograft rejection on the one hand and infectious complications on the other. BK polyomavirus nephropathy (BKPyVAN) is a viral complication that seriously threatens kidney allograft survival. Therefore, the main treatment strategy is to reduce immunosuppression, but this is associated with an increased rejection risk. Belatacept is an immunosuppressant that acts by blocking the CD80/86-CD28 co-stimulatory pathway of effector T-cells with marked effects on the humoral response. However, when compared with calcineurin-inhibitors (CNI), the cellular rejection rate is higher. With this in mind, we hypothesized that belatacept could be used as rescue therapy in severely BKPyV-affected patients with high immunological risk. We present three cases of patients with BKPyVAN-associated complications and donor-specific antibodies (DSA) and one patient who developed T-cell-mediated rejection after a reduction in immunosuppression in response to BKPyVAN. Patients were switched to a belatacept-based immunosuppressive regimen and showed significantly improved viral control and stabilized graft function. The cases presented here suggest that belatacept is a potential treatment option in the complicated situation of refractory BKPyV infection in patients with high immunological risk.
用免疫抑制治疗来平衡免疫系统对于肾移植受者至关重要，一方面可以避免移植物排斥，另一方面可以避免感染并发症。BK 多瘤病毒肾病 (BKPyVAN) 是一种严重威胁肾移植存活的病毒并发症。因此，主要的治疗策略是减少免疫抑制，但这会增加排斥的风险。巴利昔单抗是一种免疫抑制剂，通过阻断效应 T 细胞上的 CD80/86-CD28 共刺激途径发挥作用，对体液免疫有显著影响。然而，与钙调磷酸酶抑制剂 (CNI) 相比，细胞排斥率更高。考虑到这一点，我们假设巴利昔单抗可用于高免疫风险的严重 BKPyV 感染患者的挽救治疗。我们报告了 3 例 BKPyVAN 相关并发症和供体特异性抗体 (DSA) 的患者，以及 1 例因 BKPyVAN 而减少免疫抑制后发生 T 细胞介导排斥反应的患者。患者转为基于巴利昔单抗的免疫抑制方案后，病毒得到了明显控制，移植物功能得到了稳定。这里提出的病例表明，在高免疫风险患者中，巴利昔单抗是治疗难治性 BKPyV 感染的一种潜在治疗选择。
