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Renal Transplantlı Hastalarda BK Virüs Nefropatisi: Bir Merkezin Deneyimi

BK Virus Nephropathy in Renal Transplant Recipients: A Single Centre Experience

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2009

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Introduction: BK virus nephropathy is an important cause of allograft failure in renal transplant recipients that is linked to highly potent immunosuppressive theraphy. We aimed to exhibit experience of our centre with BK virus nephropathy. Material and method: We retrospectively investigated 11 patients with BK virus nephropathy among 412 patients who received renal transplantation and followed up between 2000 and 2008 in our centre. Results : The mean age of 11 patients (7 male, 4 female) with BK virus nephropathy was 32±13 years. The mean follow up period of living (n=8) and cadaveric (n=3) transplantation was 32±20 months. The mean duration between transplantation and BK virus nephropathy diagnosis was 12±8 months. Diagnosis of BK virus nephropathy was confirmed by biopsy in transplanted kidney in 9 patients. While the mean of basal creatinine was 1.28±0.40 mg/dl, creatinine level of patients during diagnosis was 3.12±1.5 mg/dl. Eight patients were on tacrolimus (FK), mycophenolat mofetil (MMF) and steroid therapy, 2 patients on cyclosporine (CSA), MMF and steroid and the other patient on CSA, sirolimus and steroid as immunosuppressive therapy regimen during diagnosis. In order to reduce immunosuppressive dosage, FK and CSA was discontinued in 7 patients, sirolimus was started in 4 of 7 patients and the dose of MMF was decreased. While cidofovir was given to all patients, intravenous immunoglobulin could be given to only 8 patients. Acute rejection was diagnosed in three patients by allograft biopsy and they were treated by steroid pulse treatment. The follow-up period of patients with BK virus nephropathy was 19±20 months (3-59 months). Eight patients had stable graft function while three patients returned to dialysis at the end of the follow-up period. The mean last creatinine level of the 8 stable patients was 2.4±1.0 mg/dl. Two of 3 patients lost grafts after acute rejection while renal functions turned to basal levels in the other patient. Conclusion: The incidence of BK virus nephropathy was found to be 2.6% in our center. Stabilization could be achieved in the great majority of our patients by reduction of immunosupressive dosage and cidofovir treatment. It is thought that there may be a strong relationship between graft loss and acute rejection.
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Abstract (Original Language): 
GİRİŞ: BK virüs nefropatisi, renal transplantlı hastalarda graft kaybının önemli sebeplerinden biri olup aşırı immunosupresif tedavi ile ilişkili olduğu düşünülmektedir. Bu çalışmada, merkezimizin BK virus nefropati deneyimlerini değerlendirmeyi amaçladık. GEREÇ ve yöntem : Bu çalışmada, 2000 ile 2008 yılları arasında renal transplantasyon yapılmış ve ünitemizde takip edilen 412 hasta arasından BK virüs nefropatisi tanısı konulan 11 hasta retrospektif olarak değerlendirildi. Bulgular : BK virüs nefropatisi tanısı konulan 11 hastanın (7 kadın, 4 erkek) yaş ortalaması 32±13 yıldı. Canlı (n=8) ve kadavra (n=3) vericilerinden böbrek transplantasyonu yapılmış olan hastaların ortalama takip süresi 32±20 ay olarak saptandı. Transplantasyon tarihinden, BK virüs nefropatisi saptanana kadar geçen süre ortalaması 12±8 ay idi. BK virus nefropatisi, tüm hastalarda transplante böbrek biyopsisi yapılarak doğrulandı. Hastaların bazal kreatinin seviyeleri ortalaması 1,28±0,40 mg/dl iken, hastaların tanı sırasında ortalama kreatinin seviyeleri 3,12±1,5 mg/dl olarak bulundu. Sekiz hastanın tanı sırasında immünosupresif tedavi rejimi takrolimus (FK), mikofenolat mofetil (MMF) ve steroid iken, diğer 2 hasta siklosporin (CSA), MMF ve steroid, 1 hasta ise CSA, sirolimus ve steroid tedavisi almaktaydı. Tedavide immünosupresyon dozlarını azaltmak amacıyla 7 hastada FK ve CSA kesilirken, 4 hastada da sirolimusa geçildi ve 7 hastada MMF dozları azaltıldı. Tüm hastalara sidofovir verilirken, intravenöz immunoglobulin 8 hastaya verilebildi. Takip sırasında allograft biopsisi ile akut rejeksiyon tanısı konulan 3 hastaya steroid pulse tedavisi uygulandı. Hastalar, BK virüs nefropatisinden sonra ortalama 19±20 ay takip edildiler (3-59 ay). Takip süresi sonrasında 8 hastanın graft fonksiyonları stabil giderken, 3 hasta diyalize döndü. Graft fonksiyonları stabil hastaların son kreatinin düzeylerinin ortalaması 2,4±1,0 mg/dl olarak bulundu. Akut rejeksiyon saptanmış 3 hastadan 2’si graftını kaybederken diğer hastanın böbrek fonksiyonları bazal değerlere döndü. Sonuç : Merkezimizin BK virüs nefropatisi insidansı %2,6 olarak bulundu. İmmünosupressif tedavinin azaltılması ve sidofovir tedavisi ile hastaların çoğunda stabilizasyon sağlandı. BKVN hastalarda, eşlik eden akut rejeksiyon ile graft kaybı arasında sıkı bir ilişkili görülmektedir. Ancak erken evrede tanı konulabilirse ve akut rejeksiyon yeterince kontrol altına alınabilirse bu tedavi yaklaşımlarıyla iyi klinik sonuçlar alınabilir.
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  • 3
117-122
  • Turkish

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