Pharmacy Department, UConn John Dempsey Hospital, Farmington, CT, USA.
Transplant Department, Hartford HealthCare, Hartford, CT, USA.
Am J Health Syst Pharm. 2024 Jan 5;81(2):56-60. doi: 10.1093/ajhp/zxad250.
A case of BK nephropathy in a kidney transplant recipient who received an organ from a hepatitis C virus (HCV)-positive donor is reported.
A 66-year-old male negative for HCV with chronic kidney disease secondary to diabetic glomerulosclerosis received a kidney transplant from an HCV-viremic donor. His initial postoperative course was uncomplicated, and HCV treatment with glecaprevir/pibrentasvir was initiated after discharge. On postoperative day (POD) 60, the patient developed BK viremia and his mycophenolate mofetil dose was decreased. Over the next few months, the BK viral load increased, with mycophenolate mofetil stopped and the tacrolimus goal lowered in response. On POD 130, the patient was admitted for a hypertensive crisis and found to have decreased renal function. During this hospitalization, the patient received a course of intravenous immune globulin (IVIG). Despite an initial response to the modification of immunosuppression therapy and several courses of IVIG over the following months, the patient's renal function continued to decline. At 18 months after transplantation, the patient was restarted on dialysis and taken off all immunosuppression.
Utilization of organs from HCV-positive donors in HCV-negative recipients allows for expansion of the donor pool and facilitates shorter times on the waitlist. Although initial data in HCV-discordant transplantation did not find an increased risk for opportunistic infections, more recent studies have shown that such risk may be present. This case report describes a patient who developed BK viremia and eventual allograft failure after an HCV-discordant transplantation.
报告了一例接受丙型肝炎病毒（HCV）阳性供体器官的肾移植受者发生 BK 肾病的病例。
一名 66 岁男性，因糖尿病肾小球硬化继发慢性肾脏病，对 HCV 阴性，接受 HCV 病毒血症供体的肾移植。他的术后初期过程平稳，出院后开始接受 glecaprevir/pibrentasvir 治疗 HCV。术后第 60 天，患者出现 BK 血症，减少了吗替麦考酚酯的剂量。此后几个月，BK 病毒载量增加，停用吗替麦考酚酯，降低他克莫司的靶目标。术后第 130 天，患者因高血压危象入院，发现肾功能下降。在此次住院期间，患者接受了静脉注射免疫球蛋白（IVIG）治疗。尽管最初通过调整免疫抑制治疗和随后几个月的多次 IVIG 治疗有了初步反应，但患者的肾功能持续下降。移植后 18 个月，患者重新开始透析并停用所有免疫抑制剂。
在 HCV 阴性受者中使用 HCV 阳性供体器官可扩大供体库，并缩短等待时间。尽管 HCV 不一致移植的最初数据并未发现机会性感染风险增加，但最近的研究表明，这种风险可能存在。本病例报告描述了一名 HCV 不一致移植后发生 BK 血症和最终移植物失功的患者。
