留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

来氟米特用于抢救性治疗减免免疫抑制剂无效的肾移植术后BK病毒性肾病的体会:附4例报告

范宇 李纪岗 钱叶勇 石炳毅 解俊杰

范宇, 李纪岗, 钱叶勇, 等. 来氟米特用于抢救性治疗减免免疫抑制剂无效的肾移植术后BK病毒性肾病的体会:附4例报告[J]. 器官移植, 2016, 7(1): 48-52,71. doi: 10.3969/j.issn.1674-7445.2016.01.009
引用本文: 范宇, 李纪岗, 钱叶勇, 等. 来氟米特用于抢救性治疗减免免疫抑制剂无效的肾移植术后BK病毒性肾病的体会:附4例报告[J]. 器官移植, 2016, 7(1): 48-52,71. doi: 10.3969/j.issn.1674-7445.2016.01.009
Fan Yu, Li Jigang, Qian Yeyong, et al. Experience with the application of leflunomide in rescuing therapy of BK virus nephropathy after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant: report of 4 cases[J]. ORGAN TRANSPLANTATION, 2016, 7(1): 48-52,71. doi: 10.3969/j.issn.1674-7445.2016.01.009
Citation: Fan Yu, Li Jigang, Qian Yeyong, et al. Experience with the application of leflunomide in rescuing therapy of BK virus nephropathy after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant: report of 4 cases[J]. ORGAN TRANSPLANTATION, 2016, 7(1): 48-52,71. doi: 10.3969/j.issn.1674-7445.2016.01.009

来氟米特用于抢救性治疗减免免疫抑制剂无效的肾移植术后BK病毒性肾病的体会:附4例报告

doi: 10.3969/j.issn.1674-7445.2016.01.009
基金项目: 

首都临床特色应用研究 2131107002213139

详细信息
    通讯作者:

    钱叶勇,Email:qianyy@medmail.com.cn

  • 中图分类号: R617;R512.99

Experience with the application of leflunomide in rescuing therapy of BK virus nephropathy after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant: report of 4 cases

More Information
  • 摘要:   目的  探讨抢救性应用来氟米特治疗减免免疫抑制剂无效的肾移植术后BK病毒性肾病(BKVN)的临床体会。   方法  4例肾移植术后BKVN受者,于术后第135~737日确诊,病理分期A1期2例、B1期1例、B2期1例。均在减免免疫抑制剂治疗0.5~3.0个月无效后,采用来氟米特抢救性治疗,先予50 mg/d连用3 d,达到有效治疗血药浓度后应用20 mg/d维持,观察其疗效及安全性。   结果  经过平均6个月(5~7个月)的随访,有效控制BKVN进展者3例,无效者1例(B2期)。服药过程中未发生明显不良反应。   结论  肾移植术后BKVN,在减免免疫抑制剂无效时,抢救性应用来氟米特有可能减缓BKVN进展,减少移植肾丢失的发生率。及早发现和诊断BKVN,力求病理学分期较早的情况下及时采取有效治疗措施效果较佳。

     

  • 图  1  4例患者治疗前后血清肌酐、钙神经蛋白抑制剂血药浓度与病毒尿症或血症趋势

    注:A图为例1;B图为例2;C图为例3;D图为例4

    Figure  1.  Trend of serum creatinine, blood drug concentration of calcineurin inhibitors and viruria or viremia of 4 cases before and after treatment

  • [1] Schaub S, Hirsch HH, Dickenmann M, et al. Reducing immunosuppression preserves allograft function in presumptive and definitive polyomavirus-associated nephropathy[J]. Am J Transplant,2010,10(12): 2615-2623. doi: 10.1111/ajt.2010.10.issue-12
    [2] Wu JK, Harris MT. Use of leflunomide in the treatment of polyomavirus BK-associated nephropathy[J].Ann Pharmacother,2008,42(11):1679-1685. doi: 10.1345/aph.1L180
    [3] 解俊杰,钱叶勇,石炳毅,等. 肾移植后BK病毒感染者实时荧光定量PCR检测[J]. 中国组织工程研究,2012,16(5):797-800. http://www.cnki.com.cn/Article/CJFDTOTAL-XDKF201205015.htm

    Xie JJ, Qian YY, Shi BY, et al. BK virus infection detected by real-time fluorescent quantitative PCR method after renal transplantation[J].Chin J Tissue Eng Res, 2012,16(5):797-800. http://www.cnki.com.cn/Article/CJFDTOTAL-XDKF201205015.htm
    [4] Kim H, Yang WS, Han DJ, et al. Clinical courses of renal transplant recipients with high BK viremia[J]. Transplant Proc, 2013, 45(8):2975-2979. doi: 10.1016/j.transproceed.2013.08.033
    [5] Hirsch HH, Knowles W, Dickenmann M, et al. Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients[J]. N Engl J Med,2002,347(7): 488-496. doi: 10.1056/NEJMoa020439
    [6] Geddes CC, Gunson R, Mazonakis E, et al. BK viremia surveillance after kidney transplant: single-center experience during a change from cyclosporine-to lower-dose tacrolimus-based primary immunosuppression regimen[J]. Transpl Infect Dis,2011,13(2): 109-116. doi: 10.1111/tid.2011.13.issue-2
    [7] Hirsch HH, Randhawa P, AST Infectious Diseases Community of Practice. BK polyomavirus in solid organ transplantation[J]. Am J Transplant,2013, 13(Suppl 4):179-188. http://cn.bing.com/academic/profile?id=1788698477&encoded=0&v=paper_preview&mkt=zh-cn
    [8] Alméras C, Vetromile F, Garrigue V, et al. Monthly screening for BK viremia is an effective strategy to prevent BK virus nephropathy in renal transplant recipients[J]. Transpl Infect Dis,2011,13(2): 101-108. doi: 10.1111/tid.2011.13.issue-2
    [9] Gonzalez S, Escobar-Serna DP, Suarez O, et al. BK virus nephropathy in kidney transplantation: an approach proposal and update on risk factors, diagnosis, and treatment[J]. Transplant Proc,2015, 47(6):1777-1785. doi: 10.1016/j.transproceed.2015.05.010
    [10] Schachtner T, Stein M, Sefrin A, et al. Inflammatory activation and recovering BKV-specific immunity correlate with self-limited BKV replication after renal transplantation[J]. Transpl Int,2014, 27(3):290-301. doi: 10.1111/tri.2014.27.issue-3
    [11] 邓伟明,苗芸. 肾移植术后BK病毒相关性肾病的临床诊治研究进展[J]. 器官移植,2015,6(2):120-123,130. http://www.organtranspl.com/browse/detail/qkid/71/id/101.html

    Deng WM, Miao Y. Clinical research progress on diagnosis and treatment of BK virus-associated nephropathy after renal transplantation[J]. Organ Transplant,2015,6(2):120-123,130. http://www.organtranspl.com/browse/detail/qkid/71/id/101.html
    [12] Halim MA, Al-Otaibi T, Gheith O, et al. Active management versus minimization of immunosuppressives of BK virus-associated nephropathy after a kidney transplant[J]. Exp Clin Transplant,2014,12(6):528-533. http://cn.bing.com/academic/profile?id=2337090942&encoded=0&v=paper_preview&mkt=zh-cn
    [13] 解俊杰,钱叶勇,石炳毅,等. 抢救性治疗对肾移植后BK病毒感染及其相关性肾病的临床效果[J]. 中华器官移植杂志,2013,34(2):105-109.

    Xie JJ, Qian YY, Shi BY, et al. Clinical observation of BK viremia and BK virus-associated nephropathy with rescuing therapy in renal transplant recipients[J]. Chin J Organ Transplant, 2013,34(2):105-109.
    [14] Andrei G, Snoeck R, Vandeputte M, et al. Activities of various compounds against murine and primate polyomaviruses[J]. Antimicrob Agents Chemother, 1997,41(3):587-593. http://cn.bing.com/academic/profile?id=2107610513&encoded=0&v=paper_preview&mkt=zh-cn
    [15] Zavos, G, Gazouli M, Psimenouet E, et al. Polyomavirus BK infection in Greek renal transplant recipients[J]. Transplant Proc, 2004,36(5): 1413-1414. doi: 10.1016/j.transproceed.2004.04.077
    [16] Kuypers DR. Management of polyomavirus-associated nephropathy in renal transplant recipients [J]. Nat Rev Nephrol,2012,8(7):390-402. doi: 10.1038/nrneph.2012.64
    [17] Hüttemann M, Shipkova M, Klett C, et al. Total and free plasma concentrations of the active metabolite of leflunomide in relation to therapeutic outcome in kidney transplant recipients with BK-virus nephropathy[J]. Transplant Proc,2013,45(4):1611-1613. doi: 10.1016/j.transproceed.2012.12.017
    [18] Zaman RA, Ettenger RB, Cheam H, et al. A novel treatment regimen for BK viremia[J]. Transplantation, 2014, 97(11):1166-1171. doi: 10.1097/01.TP.0000441825.72639.4f
    [19] Prince O, Savic S, Dickenmann M, et al. Risk factors for polyoma virus nephropathy[J]. Nephrol Dial Transplant,2009, 24(3):1024-1033. http://cn.bing.com/academic/profile?id=2002760966&encoded=0&v=paper_preview&mkt=zh-cn
    [20] Schachtner T, Babel N, Reinke P. Different risk factor profiles distinguish early-onset from late-onset BKV-replication[J]. Transpl Int, 2015, 28(9):1081-1091. doi: 10.1111/tri.2015.28.issue-9
  • 加载中
图(1)
计量
  • 文章访问数:  99
  • HTML全文浏览量:  94
  • PDF下载量:  15
  • 被引次数: 0
出版历程
  • 收稿日期:  2015-09-08
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2016-01-15

目录

    /

    返回文章
    返回