BK病毒肾病致首次移植肾功能丧失行再次肾移植四例

Repeat renal transplantation after allograft loss from BK virus nephropathy--Report or 4 cases

目的总结BK病毒肾病（BKVN）致首次移植肾功能丧失行再次肾移植的经验及预后观察。方法对4例因BKVN导致首次移植肾功能丧失而行再次肾移植的受者临床资料进行回顾性分析。结果4例受者中，3例再次移植前均明确BKVN导致首次移植肾功能丧失，分别经过5、9和9个月的血液透析治疗后行再次肾移植，术前血BK病毒DNA均转为阴性，其中1例再次移植术前4个月切除首次移植肾，术后抗排斥反应方案分别为环孢素A＋吗替麦考酚酯（MMF）＋泼尼松、他克莫司十MMF＋泼尼松及环孢素A＋泼尼松，分别随访9、5和26个月，血BK病毒DNA均保持阴性，移植肾功能均保持稳定。另1例受者再次移植前未明确首次移植肾功能丧失的原因，且未经透析未行移植肾切除即行再次肾移植，术后未监测BK病毒，术后4个月血肌酐升高至400μmol／L，结合两次移植肾病理证实BKVN复发，将他克莫司调整为环孢素A，随访至20个月时，血肌酐为260μmol／L。结论BKVN致首次移植肾功能丧失后可考虑行再次肾移植，术前血BK病毒转阴或切除首次移植肾、术后密切监测BK病毒并及时调整抗排斥反应方案是保证再次移植成功的关键。

Objective To summarize experience and prognosis of repeat renal transplantation after graft loss due to BK virus nephropathy （BKVN）. Methods The clinical data of 4 adult patients undergoing repeat transplantation after previous allograft loss due to BKVN were collected and analyzed retrospectively. Results Three of four patients had documented allograft loss caused by BKVN and underwent retransplantation 5 months, 9 months and 9 months respectively after hemodialysis with confirmed clearance of viremia. Allograft nephrectomy was performed on 1 of 3 patients 4 months before retransplantation. Maintenance immunosuppression was CsA ＋ MMF ＋ Pred, Tac ＋ MMF ＋ Pred and CsA ＋ Pred in these 3 patients respectively. During the follow-up period of 9 months, 5 months and 26 months, viremia kept negative and allografts function stabled normally without recurrence of BKVN. The cause of allograft loss was not illustrated in the other patient before retransplantation,which was performed without dialysis or allograft nephreetorny. BK virus was not monitored routinely after the operation. Four months later,his serum ereatinine rose up to 400μmol/L and BKVN recurrence was proved by pathological analysis of the biopsy samples of the first and the second transplantation. Tae was switched to CsA and his serum creatinine declined to 260μmol/L at 20th month. Conclusion Retransplantation can be performed on the patients with previous allograft loss due to BKVN. Allograft nephrectomy, clearance of viremia, monitoring BK virus and timely adjustment of immunosuppression were the keys to guarantee successful retransplantation.