Biopsy-proven BK virus nephropathy in renal transplant recipients: A multi-central study from Turkey (BK-TURK STUDY).

IF 1.1 4区医学 Q3 UROLOGY & NEPHROLOGY Clinical nephrology Pub Date : 2024-10-01 DOI:10.5414/CN111300

Ozkan Gungor, Hamad Dheir, Mahmud Islam, Huseyin Toz, Abdulmecit Yildiz, Ayse Sinangil, Erhan Tatar, Gulay Asci, Ozkan Ulutas, Eda Altun, Orcun Altunoren, Suheyla Apaydin, Alparslan Ersoy, Berfu Korucu, Seda Safak, Ulver Derici, Saliha Yildirim, Nurhan Seyahi, Seyda Gul Ozcan, Kadir Gokhan Atilgan, Mehmet Deniz Ayli, Caner Cavdar, Ozcan Uzun, Rahmi Yilmaz, Arda Erdut, Mustafa Sevinc, Umut Kasapoğlu, Ismail Kocyigit, Cihan Uysal, Kultigin Turkmen, Hakan Ozer, Arzu Velioglu, Ebru Ok, Bulent Kaya, Zulfikar Yilmaz, Oktay Ozkan, Egemen Cebeci, Kenan Turgutalp, Meltem Gursu, Enver Yuksel, Necmi Eren, Erkan Dervisoglu, Fatma Betul Guzel, Gursel Yildiz, Serkan Bakirdogen, Ayca Inci, Can Sevinc, Aydin Turkmen

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Abstract

Aim: BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients.

Materials and methods: Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study.

Results: 13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 ± 13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 ± 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 ± 0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m². In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy.

Conclusion: BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.

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肾移植受者中经活检证实的 BK 病毒肾病：土耳其多中心研究（BK-TURK STUDY）。

目的：BK 多瘤病毒感染是肾移植手术中一种具有挑战性的并发症。目前的处理方法还不规范，主要基于移植中心的经验报告，通常样本量较小。因此，我们旨在介绍全国范围内肾移植受者BK病毒肾病（BKVN）的治疗经验：我们的研究由来自土耳其所有地区的 30 家移植中心共同参与。只有经活检证实患有异体移植 BKVN 的病例才被纳入研究范围：筛选了来自 30 个移植中心的 13857 名患者，其中包括 207 例 BK 肾病病例。平均年龄为（46.4 ± 13.1）岁，146 例（70.5%）患者为男性。BK 肾病的平均诊断时间为移植后 15.8 ± 22.2 个月。确诊时，平均肌酐水平为 1.8 ± 0.7 mg/dL，平均肾小球滤过率为 45.8 ± 19.6 mL/min/1.73m2 。除了减量或停用免疫抑制剂外，18 名患者接受了西多福韦酯治疗，11 名患者接受了来氟米特治疗，17 名患者接受了喹诺酮类药物治疗，15 名患者接受了静脉注射免疫球蛋白（IVIG）治疗，5 名患者接受了西多福韦酯加 IVIG 治疗，12 名患者接受了来氟米特加 IVIG 治疗。在接受来氟米特或来氟米特加 IVIG 治疗的患者中，没有人发生同种异体移植物丢失。在随访期间，207 名 BK 肾病患者中有 32 人（15%）发生了同种异体移植损失：结论：BKVN仍是肾移植中导致同种异体移植物丢失的一个常见原因，目前尚未完全阐明。我们的研究结果表明，来氟米特治疗与更有利的异体移植结果相关。

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来源期刊

Clinical nephrology 医学-泌尿学与肾脏学

CiteScore

2.10

自引率

9.10%

发文量

138

审稿时长

4-8 weeks

期刊介绍： Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.