The Korean journal of internal medicine

  • 제30권6호
  • /
  • Pages.865-872
  • /
  • 2015
  • /
  • 1226-3303(pISSN)
  • /
  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Risk factors in the progression of BK virus-associated nephropathy in renal transplant recipients

  • Lee, Hae Min (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Jang, In-Ae (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Lee, Dongjae (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kang, Eun Jin (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Choi, Bum Soon (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Park, Cheol Whee (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Choi, Yeong Jin (Department of Hospital Pathology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Yang, Chul Woo (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Yong-Soo (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Chung, Byung Ha (Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • 투고 : 2014.04.14
  • 심사 : 2014.07.22
  • 발행 : 2015.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients. It has an unfavorable clinical course, and no definite treatment guidelines have yet been established. Here, we report our center's experience with biopsy-proven BKVAN and investigate factors associated with its progression. Methods: From January 2004 to April 2013, 25 patients with BKVAN were diagnosed by biopsy at Seoul St. Mary's Hospital. Of the 25 patients, 10 were deceased-donor transplant recipients and 15 were living-donor transplant recipients. Three of the patients underwent retransplantation. The primary immunosuppressant used was tacrolimus in 17 patients and cyclosporine in eight patients. Results: BKVAN was observed at a mean duration of $22.8{\pm}29.1$ months after transplantation. The mean serum creatinine level at biopsy was $2.2{\pm}0.7mg/dL$. BKVAN occurred with acute rejection in eight patients (28%). Immunosuppression modification was performed in 21 patients (84%). Additionally, leflunomide and intravenous immunoglobulin were administered to 13 patients (52%) and two (8%), respectively. Allograft loss occurred in five patients (27.8%) during the follow-up period at 0.7, 17.1, 21.8, 39.8, and 41.5 months after the BKVAN diagnosis. Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure. Conclusions: The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.

키워드

과제정보

연구 과제 주관 기관 : Ministry of Health and Welfare

참고문헌

  1. Hirsch HH. Polyomavirus BK nephropathy: a (re-)emerging complication in renal transplantation. Am J Transplant 2002;2:25-30. https://doi.org/10.1034/j.1600-6143.2002.020106.x
  2. Costa C, Bergallo M, Astegiano S, et al. Monitoring of BK virus replication in the first year following renal transplantation. Nephrol Dial Transplant 2008;23:3333-3336. https://doi.org/10.1093/ndt/gfn289
  3. Nickeleit V, Singh HK, Mihatsch MJ. Polyomavirus nephropathy: morphology, pathophysiology, and clinical management. Curr Opin Nephrol Hypertens 2003;12:599-605. https://doi.org/10.1097/00041552-200311000-00005
  4. Hirsch HH, Brennan DC, Drachenberg CB, et al. Polyomavirus- associated nephropathy in renal transplantation: interdisciplinary analyses and recommendations. Transplantation 2005;79:1277-1286. https://doi.org/10.1097/01.TP.0000156165.83160.09
  5. Hirsch HH, Steiger J. Polyomavirus BK. Lancet Infect Dis 2003;3:611-623. https://doi.org/10.1016/S1473-3099(03)00770-9
  6. Purighalla R, Shapiro R, McCauley J, Randhawa P. BK virus infection in a kidney allograft diagnosed by needle biopsy. Am J Kidney Dis 1995;26:671-673. https://doi.org/10.1016/0272-6386(95)90608-8
  7. Lee SO. Common infections in solid organ transplant recipients. Korean J Med 2013;84:145-157. https://doi.org/10.3904/kjm.2013.84.2.145
  8. Chung BH, Jung MH, Bae SH, et al. Changing donor source pattern for kidney transplantation over 40 years: a single-center experience. Korean J Intern Med 2010;25:288-293. https://doi.org/10.3904/kjim.2010.25.3.288
  9. Chung BH, Hong YA, Kim HG, et al. Clinical usefulness of BK virus plasma quantitative PCR to prevent BK virus associated nephropathy. Transpl Int 2012;25:687-695. https://doi.org/10.1111/j.1432-2277.2012.01480.x
  10. Hurault de Ligny B, Etienne I, et al. Polyomavirus-induced acute tubulo-interstitial nephritis in renal allograft recipients. Transplant Proc 2000;32:2760-2761. https://doi.org/10.1016/S0041-1345(00)01869-8
  11. Ahuja M, Cohen EP, Dayer AM, et al. Polyoma virus infection after renal transplantation: use of immunostaining as a guide to diagnosis. Transplantation 2001;71:896-899. https://doi.org/10.1097/00007890-200104150-00013
  12. Barri YM, Ahmad I, Ketel BL, et al. Polyoma viral infection in renal transplantation: the role of immunosuppressive therapy. Clin Transplant 2001;15:240-246. https://doi.org/10.1034/j.1399-0012.2001.150404.x
  13. Hirsch HH, Mohaupt M, Klimkait T. Prospective monitoring of BK virus load after discontinuing sirolimus treatment in a renal transplant patient with BK virus nephropathy. J Infect Dis 2001;184:1494-1495. https://doi.org/10.1086/324425
  14. Hirsch HH, Knowles W, Dickenmann M, et al. Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients. N Engl J Med 2002;347:488-496. https://doi.org/10.1056/NEJMoa020439
  15. Babel N, Fendt J, Karaivanov S, et al. Sustained BK viruria as an early marker for the development of BKV-associated nephropathy: analysis of 4128 urine and serum samples. Transplantation 2009;88:89-95. https://doi.org/10.1097/TP.0b013e3181aa8f62
  16. Viscount HB, Eid AJ, Espy MJ, et al. Polyomavirus polymerase chain reaction as a surrogate marker of polyomavirus- associated nephropathy. Transplantation 2007;84:340-345. https://doi.org/10.1097/01.tp.0000275205.41078.51
  17. Randhawa P, Brennan DC. BK virus infection in transplant recipients: an overview and update. Am J Transplant 2006;6:2000-2005. https://doi.org/10.1111/j.1600-6143.2006.01403.x
  18. Wiseman AC. Polyomavirus nephropathy: a current perspective and clinical considerations. Am J Kidney Dis 2009;54:131-142 https://doi.org/10.1053/j.ajkd.2009.01.271
  19. Toupance O, Bouedjoro-Camus MC, Carquin J, et al. Cytomegalovirus-related disease and risk of acute rejection in renal transplant recipients: a cohort study with case-control analyses. Transpl Int 2000;13:413-419. https://doi.org/10.1111/j.1432-2277.2000.tb01019.x
  20. Ohashi K, Burkart V, Flohe S, Kolb H. Cutting edge: heat shock protein 60 is a putative endogenous ligand of the toll-like receptor-4 complex. J Immunol 2000;164:558-561. https://doi.org/10.4049/jimmunol.164.2.558
  21. Kang YN, Han SM, Park KK, Jeon DS, Kim HC. BK virus infection in renal allograft recipients. Transplant Proc 2003;35:275-277. https://doi.org/10.1016/S0041-1345(02)03954-4
  22. Mengel M, Marwedel M, Radermacher J, et al. Incidence of polyomavirus-nephropathy in renal allografts: influence of modern immunosuppressive drugs. Nephrol Dial Transplant 2003;18:1190-1196. https://doi.org/10.1093/ndt/gfg072
  23. Drachenberg CB, Papadimitriou JC, Hirsch HH, et al. Histological patterns of polyomavirus nephropathy: correlation with graft outcome and viral load. Am J Transplant 2004;4:2082-2092. https://doi.org/10.1046/j.1600-6143.2004.00603.x
  24. Kiberd BA. Screening to prevent polyoma virus nephropathy: a medical decision analysis. Am J Transplant 2005;5:2410-2416. https://doi.org/10.1111/j.1600-6143.2005.01034.x
  25. Randhawa P, Ho A, Shapiro R, et al. Correlates of quantitative measurement of BK polyomavirus (BKV) DNA with clinical course of BKV infection in renal transplant patients. J Clin Microbiol 2004;42:1176-1180. https://doi.org/10.1128/JCM.42.3.1176-1180.2004
  26. Kim YJ, Jeong JC, Koo TY, et al. Impact of combined acute rejection on BK virus-associated nephropathy in kidney transplantation. J Korean Med Sci 2013;28:1711-1715. https://doi.org/10.3346/jkms.2013.28.12.1711

피인용 문헌

  1. BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection vol.6, pp.3, 2015, https://doi.org/10.5500/wjt.v6.i3.472
  2. Open the black box; is urine valuable for screening BK virus-associated nephropathy? vol.35, pp.3, 2015, https://doi.org/10.1016/j.krcp.2016.08.003
  3. Incidence, risk factors and the effect of polyomavirus infection in hematopoietic stem cell transplant recipients vol.45, pp.2, 2015, https://doi.org/10.1177/0300060517691795
  4. Tacrolimus Blood Level Fluctuation Predisposes to Coexisting BK Virus Nephropathy and Acute Allograft Rejection vol.7, pp.None, 2015, https://doi.org/10.1038/s41598-017-02140-1
  5. Bortezomib Treatment for Refractory Antibody-Mediated Rejection Superimposed with BK Virus-Associated Nephropathy during the Progression of Recurrent C3 Glomerulonephritis vol.32, pp.3, 2018, https://doi.org/10.4285/jkstn.2018.32.3.57
  6. An immunoinformatic approach to universal therapeutic vaccine design against BK virus vol.37, pp.26, 2019, https://doi.org/10.1016/j.vaccine.2019.04.096
  7. BK Polyomavirus Virus Glomerular Tropism: Implications for Virus Reactivation from Latency and Amplification during Immunosuppression vol.8, pp.9, 2015, https://doi.org/10.3390/jcm8091477