目的 评估肾移植术后咪唑立宾(MZR)转换治疗对BK病毒(BKV)感染的疗效及安全性.方法 收集2015年2月至2016年12月在住院及门诊进行BK病毒筛查的受者资料,根据入选及排除标准将BK病毒阳性受者分成实验组(咪唑立宾转换治疗组)和对照组(未转换组),评估咪唑立宾转换治疗后BK病毒的转阴率及急性排斥反应、高尿酸血症和移植肾功能.结果 2015年2月至2016年12月共有182例受者接受了BKV-DNA筛查,外周血阳性13例、中段尿67例,外周血及中段尿阳性率分别为7.1%和36.8%.27例受者纳入实验组,36例为对照组.咪唑立宾转换治疗期间,实验组BK病毒转阴率为51.9%,BK病毒转阴时间为转换治疗后(3.2±2.7)个月(1~10个月),实验组仅有1例发生急性排斥反应.经药物治疗,转换前后血尿酸值无变化.2组受者术后肾功能维持稳定,均未出现死亡及移植肾功能丧失案例,受者和移植肾的2年存活率为100%.结论 肾移植术后BK病毒感染发生率高,肾移植术后采用咪唑立宾转换方案治疗BK病毒感染安全有效.
Objective To analyze the incidence of BK virus (BKV) infection after kidney transplantation in our center and to evaluate the efficacy and safety of conversion treatment with Mizoribine (MZR) on BKV infection after kidney transplantation.Methods The information of recipients who received BK virus screening in hospital or outpatient during 2015-02 to 2016-12 in our center was retrospectively analyzed.The recipients positive for BKV were divided into experiment group (given conversion treatment with MZR) and control group (not given MZR conversion) according to the inclusion criteria.The negative rate of BKV,AR,hyperuricemia and the function of renal allograft during the conversion treatment with MZR were observed.Results 182 recipients accepted BKV screening during 2015-02 to 2016-12 and 68 cases were positive.The positive rate of BKV was 38.5 %.The positive rate of peripheral blood specimens and midstream urine specimens was 7.1% and 36.8% respectively.Twelve recipients were positive for BKV in both peripheral blood specimens and midstream urine specimens.There were 27 recipients in experiment group and 36 cases in control group.Fourteen recipients positive for BKV became negative after MZR conversion in experiment group and the negative rate was up to 51.9%.The mean time of negative rate was 3.2 ± 2.7 (1-10) months after MZR conversion.During the conversion treatment with MZR,AR occurred in 1 case and was reversed by the impact therapy with Thymoglobulin in experiment group.The value of serum uric acid was maintained stable before and after MZR conversion under the action of uric-acidlowering drug.The renal function was kept stable in both experiment group and control group after renal transplantation.No deaths and renal allograft failure cases occurred in both groups during the research period.The 2-year survival rate for patients and kidneys was both 100%.Conclusion The incidence of BKV infection after kidney transplantation was high and the treatment scheme of MZR conversion was safe and effective.