Eda ALTUN, Sena ULU, Süheyla APAYDIN, Bahtışen GÜVEN

Böbrek nakli hastalarında biyopsi ile kanıtlanmış BK virüs nefropatisi: risk faktörleri, sıklığı ve tedavi yaklaşımı

Amaç: BK virüs nefropatisi (BKVN) böbrek nakli sonrasında immunsupresif tedavi dozu ile yakından ilişkili, latent enfeksiyonun reaktivasyonudur. Bu çalışmada kliniğimizde takipli hastalarda BKVN sıklığını ve olası risk faktörlerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Nisan 2014- Nisan 2020 tarihleri arasında kliniğimizden takipli olan 422 böbrek nakil hastası BK virus nefropati açısından geriye dönük oalrak analiz edildi. Gruo I’e biyopsi ile kanıtlanmış BK virus nefroatili 16 hasta, grup II’ye ise BK virus negatif olan 36 hasta dahil edildi. BKVN saptanan 16 hastanın (grup I) ve BKVN negatif olan 36 hastanın (grup II) demografik, klinik ve laboratuar özellikleri özellikleri ile BKVN ilişkili faktörler karşılaştırıldı. Bulgular: Grup I’deki hastaların yaş ortalaması 41±14.8 yıl, grup II’deki hastaların yaş ortalaması ise 39±15.2 yıl olarak saptandı. Hastaların böbrek nakli sonrasında ortalama takip süreleri 43±11.2 ay idi. BKVN olan grupta serum kreatinin ve proteinüri düzeyinin istatistiksel anlamlı olarak daha yüksek olduğu saptandı. BKVN saptanan hastalarda immunsupresyon dozunu azaltmak amacı ile 8 hastada kullanmakta oldukları takrolimus tedavisi kesilerek everolimus +MMF+ prednisone tedavisine, 4 hastada leflunamid+ MMF+ prednisone tedavisine, 4 hastada ise sirolimus +MMF+ prednisone tedavisine geçiş yapıldı. BKVN tanısı sonrasında hastaların ortalama 58.9±34.2 ay takip edildiği, 1 hastada NODAT geliştiği, 2 hastanın kardiyovasküler nedenlerle kaybedildiği, 2 hastanın ise greft kaybı nedeni ile hemodiyaliz tedavisine döndüğü gözlendi. Takibe devam eden hastaların ortalama serum kreatinin değerlerinin 1.78±0.98 mg/dl olarak gözlendi. Sonuç: Kliniğimizde çalışmanın yapıldığı dönemde BKVN sıklığı %4.86 olarak gözlendi. İmmunsupresif tedavi dozunun azaltılması hala en etkin tedavi yöntemidir. Leflunamid tedavisi ile diğer tedavi yaklaşımları arasında fark olmadığı saptandı. Sık aralıklarla tarama ve erken tanının BKVN takibinde daha etkili olduğu gözlenmiştir.

Anahtar Kelimeler:

bk virus, nefropati, böbrek nakli

Biopsy-proven BK virus nephropathy in kidney transplant patients: risk factors, prevalence and treatment approach

Purpose: BK virus nephropathy (BKVN) is a latent infection and it is closely associated with immunsuppressive therapy. We aimed in this study to evaluate biopsy-proven BKVN and investigate frequency, risk factors and treatment management. Materials and Methods: In this study, 422 kidney transplant recipients were analysed retrospectively between April 2014 and April 2020 for biopsy-proven BK virus nephropathy. Group I included 16 kidney transplant patients with biopsy-proven BK nephropathy and group II included 36 kidney transplant patients with negative BK virus nephropathy. We aimed demographic, clinical features of kidney transplant recipients with BKVN (group I, n: 16 ) and non-BKVN (group II, n:36) were compared and the factors affecting of BKVN. Results: The mean age of grup I and group II were were 41±14.8 years and 39±15.2 respectively. The patients mean follow-up period of 43±11.2 months. Serum creatinine and proteinuria degree were significantly higher in the group with BKVN. In order to reduce the dose of immunosuppression in patients with BKVN, tacrolimus treatment was discontinued in 8 patients, and they were switched to everolimus + MMF + prednisone treatment, leflunamide + MMF + prednisone treatment in 4 patients, and sirolimus + MMF + prednisone treatment in 4 patients. The mean serum creatinine level of the patients who were followed up were observed as 1.78±0.98 mg/dl in group I. Conclusion: In our center, the prevalance of BKVN was found 3.92% during the study period. Reduction of dose immunosuppressive therapy is the most effective treatment. It is thought that there was no differences between Leflunamide and other approaches for treatment. Early diagnosis and screening (frequently intervals) seems to be most effective way for BKVN.

Keywords:

bk virus, nephropathy, kidney transplantation,

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