Barış ESER, Özlem YAYAR, Mustafa ŞAHİN, Ünsal SAVCI, Başol CANBAKAN, Mehmet Deniz AYLI

Böbrek transplantasyonu sonrası nefropati ile ilişkili BK virüsü: tek merkez deneyimi

Amaç: BK virüs (BKV) nefropatisi, böbrek transplant alıcılarında allogreft başarısızlığının önemli bir nedeni olup, yüksek derecede potent olan immünsupresif tedaviye bağlıdır. Bu çalışmada BKV viremisi ve BKV ile ilişkili nefropati (BKVN) ile ilişkili risk faktörleri ve tedaviye yanıt da değerlendirildi.Gereç ve Yöntem: 2008 ve 2014 yılları arasında kadavra kökenli veya canlı ilişkili vericilerden retrospektif olarak 107 renal transplant hastasını analiz ettik. Transplantasyondan sonra, tüm hastalarda vireminin varlığı için BKV polimeraz zincir reaksiyonu (PCR) taraması yaptık. Periferik kan numuneleri ilk üç ayda bir tarama için, daha sonra her üç ayda bir ilk nakil yılının sonuna kadar toplandı. BKV DNA kopyaları gerçek zamanlı PCR ile ölçüldü. Allogreft biyopsileri klinik endikasyona göre yapıldı. Tüm biyopsiler Banff kriterlerine göre analiz edildi ve BKVN varlığı açısından değerlendirildi.Bulgular: Yüzyedi hastanın 14'ünde (% 13,1) (12 viremi/6 BKVN) BK virüsü ile ilişkili hastalık tespit edildi. BKV ilişkili hastalığı olan (Group I, n:14) ve olmayan hastalar (Group II, n:93) demografik, klinik ve laboratuvar bulgularına göre karşılaştırıldı. BKV ilişkili hastalığı olanlarda serum kreatinin düzeyleri istatistiksel anlamlı olarak daha yüksek bulundu. Ayrıca, yaşlılık ve takrolimus kullanımının BKVN gelişimi için önemli risk faktörleri olduğu saptandı (p <0.05). BKV ile ilişkili hastalığı olanlarda immunsüpresif tedavi dozu azaltıldı ve 1 ay boyunca oral 500 mg/gün levofloksasin kullanıldı. Bu hastalardan greft fonksiyon bozukluğu devam eden üç hastada mikofenolik asit tedavisi durduruldu ve oral 40 mg/gün leflunomid tedavisi eklendi. Leflunomid tedavisi BKV viremisi kaybolup greft fonksiyonu düzelene kadar devam edildi.Sonuç: BKVN gelişiminde takrolimus kullanımı siklosporinden daha yüksek bir risk ile ilişkilidir. BKVN greft kaybına yol açtığından, BKV replikasyonu için böbrek nakli yapılan hastalar düzenli olarak taranmalıdır. Günümüzde immünsüpresyon dozunun azaltılması en sık görülen tedavi yaklaşımıdır. Ek olarak, leflunomid kullanımı ilave bir tedavi seçeneği gibi gözükmektedir. ğından, BKV replikasyonu için böbrek nakli yapılan hastalar düzenli olarak taranmalıdır. Günümüzde immünsüpresyon dozunun azaltılması en sık görülen tedavi yaklaşımıdır. Buna ek olarak, levofloksasin ve leflunomid kullanımı ilave bir tedavi seçeneği gibi gözükmektedir.

Anahtar Kelimeler:

BK virüsü, renal transplantasyon, nefropati

BK virus associated nephropathy after renal transplantation: a single center experience

Aim: BK virus (BKV) nephropathy is an important cause of allograft failure in renal transplant recipients that is linked to highly potent immunosuppressive therapy. The risk factors associated BKV viremia and BKV associated nephropathy (BKVN) and response to therapy were also evaluated in this study. Material and Method: We retrospectively analyzed 107 renal transplant patients from cadaveric or living related donors between 2008 and 2014. After transplantation, we performed BKV polymerase chain reaction (PCR) assay screening for the presence of viremia in all patients. Peripheral blood samples were collected for screening monthly for first three months, after then every three months until the end of the first transplant year. BKV DNA copies were measured by real time PCR. Allograft biopsies were performed in the presence of clinical indication. All biopsies were analyzed according to Banff criteria and evaluated for the presence of BKVN. Results: BK virus associated disease was totally detected in 14 patients (13,1%) (12 viremia/6 BKVN) of 107 patients. Demographic, clinical and laboratory findings of BKV-related patients (Group I, n: 14) and non-BKV related patients (Group II, n: 93) were compared. Serum creatinine levels were statistically significantly higher in patients with BKV related disease. Additionally, it was detected that older age and tacrolimus usage are important risk factors for developing BKVN (p< 0.05). In all cases with BKV associated diseases were managed by reducing immunosuppression and, we used oral 500 mg/day levofloxacin for 1 month for all patients. Additionally in three patients with persistent allograft dysfunction following BKVN, the mycophenolic acid was stopped and oral 40 mg/day leflunomide was subsequently started. Leflunomide therapy continued until the BKV viremia disappeared and graft function was improved in the patients Conclusion: The use of tacrolimus for BKVN development is associated with a significantly higher risk than cyclosporine. Because BKVN leads to graft loss, renal transplant patients should be screened regularly for BKV replication. Nowadays, reduction of dose immunosuppression is the most common treatment approach. In addition, the use of leflunomide appears to be an additional treatment option.

Keywords:

BK virus, renal transplantation, nephropathy,

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