Mosca M, Bacchetta J, Chamouard V, Rascle P, Dubois V, Paul S, Mekki Y, Picard C, Bertholet-Thomas A, Ranchin B, Sellier-Leclerc A L
Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Centre de Référence des Maladies Rénales Rares, Bron Cedex F-69677, France.
Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Centre de Référence des Maladies Rénales Rares, Bron Cedex F-69677, France.
Arch Pediatr. 2023 Apr;30(3):165-171. doi: 10.1016/j.arcped.2023.01.005. Epub 2023 Mar 10.
BK virus-associated nephropathy (BKPyVAN) induces kidney allograft dysfunction. Although decreasing immunosuppression is the standard for managing BK virus (BKPyV) infection, this strategy is not always effective. The use of polyvalent immunoglobulins (IVIg) may be of interest in this setting. We performed a retrospective single-center evaluation of the management of BKPyV infection in pediatric kidney transplant patients. Among the 171 patients who underwent transplantation between January 2010 and December 2019, 54 patients were excluded (combined transplant n = 15, follow-up in another center n = 35, early postoperative graft loss n= 4). Thus, 117 patients (120 transplants) were included. Overall, 34 (28%) and 15 (13%) transplant recipients displayed positive BKPyV viruria and viremia, respectively. Three had biopsy-confirmed BKPyVAN. The pre-transplant prevalence of CAKUT and HLA antibodies was higher among BKPyV-positive patients compared to non-infected patients. After the detection of BKPyV replication and/or BKPyVAN, the immunosuppressive regimen was modified in 13 (87%) patients: either by decreasing or changing the calcineurin inhibitors (n = 13) and/or switching from mycophenolate mofetil to mTor inhibitors (n = 10). Starting IVIg therapy was based on graft dysfunction or an increase in the viral load despite reduced immunosuppressive regimen. Seven of 15(46%) patients received IVIg. These patients had a higher viral load (5.4 [5.0-6.8]log vs. 3.5 [3.3-3.8]log). In total, 13 of 15 (86%) achieved viral load reduction, five of seven after IVIg therapy. As long as specific antivirals are not available for the management of BKPyV infections in pediatric kidney transplant patients, polyvalent IVIg may be discussed for the management of severe BKPyV viremia, in combination with decreased immunosuppression.
BK病毒相关性肾病（BKPyVAN）可导致肾移植受者的移植肾功能障碍。尽管降低免疫抑制是治疗BK病毒（BKPyV）感染的标准方法，但该策略并非总是有效。在这种情况下，使用多价免疫球蛋白（IVIg）可能会有帮助。我们对小儿肾移植患者BKPyV感染的治疗进行了一项回顾性单中心评估。在2010年1月至2019年12月期间接受移植的171例患者中，排除了54例（联合移植n = 15，在另一个中心随访n = 35，术后早期移植肾丢失n = 4）。因此，纳入了117例患者（120次移植）。总体而言，分别有34例（28%）和15例（13%）移植受者的BKPyV病毒尿和病毒血症呈阳性。3例经活检确诊为BKPyVAN。与未感染患者相比，BKPyV阳性患者移植前CAKUT和HLA抗体的患病率更高。在检测到BKPyV复制和/或BKPyVAN后，13例（87%）患者的免疫抑制方案进行了调整：要么减少或更换钙调神经磷酸酶抑制剂（n = 13）和/或从霉酚酸酯转换为mTor抑制剂（n = 10）。开始IVIg治疗的依据是移植肾功能障碍或尽管免疫抑制方案已减少但病毒载量仍增加。15例患者中有7例（46%）接受了IVIg治疗。这些患者的病毒载量更高（5.4 [5.0 - 6.8]log对3.5 [3.3 - 3.8]log）。总共15例患者中有13例（86%）实现了病毒载量降低，7例接受IVIg治疗的患者中有5例实现了病毒载量降低。在小儿肾移植患者中，只要尚无用于治疗BKPyV感染的特异性抗病毒药物，就可以考虑使用多价IVIg联合降低免疫抑制来治疗严重的BKPyV病毒血症。
