儿童肾移植后细小病毒B19感染的临床特点及诊治经验探讨

Clinical characteristics,diagnosis,and treatment of parvovirus b19 infection in pediatric kidney transplant patients

目的结合本中心及国内外文献总结儿童肾移植术后细小病毒B19(parvovirus B19,PVB19感染的临床特点及诊治经验。方法纳入2004年1月—2018年12月在复旦大学附属儿科医院进行规律肾移植后随访的131例患儿。结合文献分析患者临床资料、实验室数据、治疗及预后。结果本中心儿童肾移植后PVB19感染发生率为3.8%(5/131),经静脉丙种球蛋白(intravenous,gammaglobulin,IVIG)治疗、免疫抑制剂撤减和输血,除1例原发病复发,余预后良好。国内外20例患者平均移植年龄为(11.6±4.0)岁;男孩19例,移植后中位确诊时间为50(19,75)d。贫血最常见,部分伴有低白细胞血症、发热、血小板降低和全血细胞减少、脑炎等。80%接受IVIG,70%需输血,50%免疫抑制剂撤减,3例未治疗自愈。感染后贫血中位持续时间1(0.9~4.8)个月。随访生存率为100%,但2例分别因血栓和原发病复发致移植物失功。结论PVB19感染多在儿童肾移植后较早期发生,男孩多见,贫血为主要临床表现。IVIG输注和免疫抑制撤减可有效控制感染,总体预后良好。

Objective To summarize the clinical characteristics,diagnosis and treatment experience of parvovirus B19(PVB19)infection after kidney transplantation in children based on the cases of our center and review of recent literature.Methods From January 2004 to December 2018,131 children who underwent regular follow-up after kidney transplantation at Children’s Hospital of Fudan University were enrolled.Medical records including clinical and laboratory data,treatment and prognosis were analyzed.A systematic literature search for PVB19 infection after kidney transplantation in pediatric recipients was performed.Results The incidence of PVB19 infection in children after kidney transplantation in our center was 3.8%(5/131).After diagnosis,all 5 children received intravenous gamma globulin(IVIG)infusion therapy and blood transfusion,the dose of immunosuppressive agents was decreased.Except for 1 case of recurrence of primary IgA nephropathy,the prognosis of the other 4 cases were good.According to the analysis of 20 children infected with PVB19 after kidney transplantation(including these 5 cases in our center)from the literature review,an average transplant age was(11.6±4.0)years.Nineteen cases were boys and only 1 case from our center was a girl.The median time from transplant to the diagnosis of PVB19 infection was 50(19,75)days.Anemia was the most common clinical manifestation of PVB19 infection in children,with an incidence of 90%(18/20).Leukopenia,fever,thrombocytopenia,pancytopenia,and encephalitis were present.IVIG was used as treatment for PVB19 infection for 80%of patients.70%of the children received blood transfusion.50%of the children received decreased of immunosuppressants,while 3 children did not receive treatment.The median duration of anemia after infection was 1(0.9~4.8)month.Three cases relapsed within 2~3 months after the anemia was relieved and were treated again.The symptoms improved afterwards.The survival rate of the children at the follow-up end point was 100%,but graft failures occurred in 2 cases due to thrombosis and recurrence of the primary disease.Conclusion PVB19 infection mostly occurs early after kidney transplantation in children,and it is more common in boys.Anemia is the most common clinical manifestation in children.IVIG infusion and immunosuppressants decreasing can effectively control PVB19 infection,and the overall prognosis is good.