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器官移植受者BK病毒感染和BK病毒性肾病临床诊疗规范(2019版)

中华医学会器官移植学分会

中华医学会器官移植学分会. 器官移植受者BK病毒感染和BK病毒性肾病临床诊疗规范(2019版)[J]. 器官移植, 2019, 10(3): 237-242. doi: 10.3969/j.issn.1674-7445.2019.03.003
引用本文: 中华医学会器官移植学分会. 器官移植受者BK病毒感染和BK病毒性肾病临床诊疗规范(2019版)[J]. 器官移植, 2019, 10(3): 237-242. doi: 10.3969/j.issn.1674-7445.2019.03.003
Branch of Organ Transplantation of Chinese Medical Association. Clinical diagnosis and treatment specifcation for BK virus infection and BK virus nephropathy in organ transplant recipients in China (2019 edition)[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 237-242. doi: 10.3969/j.issn.1674-7445.2019.03.003
Citation: Branch of Organ Transplantation of Chinese Medical Association. Clinical diagnosis and treatment specifcation for BK virus infection and BK virus nephropathy in organ transplant recipients in China (2019 edition)[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 237-242. doi: 10.3969/j.issn.1674-7445.2019.03.003

器官移植受者BK病毒感染和BK病毒性肾病临床诊疗规范(2019版)

doi: 10.3969/j.issn.1674-7445.2019.03.003
基金项目: 

国家自然科学基金 81570680

国家自然科学基金 81571555

详细信息
    通讯作者:

    石炳毅,Email:shibingyi666@126.com

  • 中图分类号: R617, R692.5, R373

Clinical diagnosis and treatment specifcation for BK virus infection and BK virus nephropathy in organ transplant recipients in China (2019 edition)

  • 摘要: 为了进一步规范中国实体器官移植受者BK病毒(BKV)感染和BKV性肾病(BKVN)的诊断和治疗,中华医学会器官移植学分会组织器官移植专家和感染病学专家,在《中国实体器官移植受者BK病毒感染临床诊疗指南(2016版)》的基础上,从概述和流行病学特点、临床表现、诊断、预防、治疗、随访、预后等方面,制订本规范,以帮助器官移植工作者规范和优化BKV感染及相关疾病的诊断和治疗。

     

  • 表  1  BKVN发生的危险因素

    Table  1.   Risk factors of BKVN

    分类 危险因素
    供者因素 HLA错配
    尸体供肾
    女性
    受者因素 高龄
    男性
    移植后其他因素 手术损伤、冷缺血时间
    输尿管支架、输尿管狭窄
    急性排斥反应和抗排斥反应治疗
    大量糖皮质激素暴露
    抗淋巴细胞抗体
    强效免疫抑制方案他克莫司联合吗替麦考酚酯
    因BKVN致移植物失功后再次移植
    HLA为人类白细胞抗原
    下载: 导出CSV

    表  2  BKVN分型及预后情况

    Table  2.   Classification and prognosis of BKVN

    BKVN分型 病理学表现 病变程度 病变范围 移植物功能 移植器官功能衰竭风险
    A型 病毒导致的细胞病理学改变 轻微 ≤25% 大多在基线 < 10%
    间质炎症 较轻 ≤10%
    肾小管萎缩 较轻 ≤10%
    间质纤维化 较轻 ≤10%
    B型 病毒导致的细胞病理学改变 多样 11%~50% 大多有受损 50%
    间质炎症 明显 11%~50%
    肾小管萎缩 中等 < 50%
    间质纤维化 中等 < 50%
      B1型 间质炎症 中等 11%~25% 略高于基线 25%
      B2型 间质炎症 明显 26%~50% 明显受损 50%
      B3型 间质炎症 广泛 > 50% 明显受损 50%
    C型 病毒导致的细胞病理学改变 多样 多样 明显受损,进展至功能衰竭 > 80%
    间质炎症 多样 多样
    肾小管萎缩 广泛 > 50%
    间质纤维化 广泛 > 50%
    下载: 导出CSV
  • [1] SAWINSKI D, GORAL S. BK virus infection: an update on diagnosis and treatment[J]. Nephrol Dial Transplant, 2015, 30(2):209-217. DOI: 10.1093/ndt/gfu023.
    [2] 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. DOI: 10.1111/ajt.12110.
    [3] HIRSCH HH, BABEL N, COMOLI P, et al. European perspective on human polyomavirus infection, replication and disease in solid organ transplantation[J]. Clin Microbiol Infect, 2014, 20 (Suppl 7): 74-88. DOI: 10.1111/1469-0691.12538.
    [4] Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients[J]. Am J Transplant, 2009, 9 (Suppl 3): S1-S155. DOI: 10.1111/j.1600-6143.2009.02834.x.
    [5] EGLI A, INFANTI L, DUMOULIN A, et al. Prevalence of polyomavirus BK and JC infection and replication in 400 healthy blood donors[J]. J Infect Dis, 2009, 199(6): 837-846. doi: 10.1086/598679
    [6] HIRSCH HH, STEIGER J. Polyomavirus BK[J]. Lancet Infect Dis, 2003, 3(10):611-623. doi: 10.1016/S1473-3099(03)00770-9
    [7] CANNON RM, OUSEPH R, JONES CM, et al. BK viral disease in renal transplantation[J]. Curr Opin Organ Transplant, 2011, 16(6): 576-579. DOI: 10.1097/MOT.0b013e32834cd666.
    [8] SELLARÉS J, DE FREITAS DG, MENGEL M, et al. Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence[J]. Am J Transplant, 2012, 12(2):388-399. DOI: 10.1111/j.1600-6143.2011.03840.x.
    [9] HUANG G, CHEN LZ, QIU J, et al. Prospective study of polyomavirus BK replication and nephropathy in renal transplant recipients in China: a single-center analysis of incidence, reduction in immunosuppression and clinical course[J]. Clin Transplant, 2010, 24(5): 599-609. DOI: 10.1111/j.1399-0012.2009.01141.x.
    [10] 王新颖, 范宇, 韩永, 等. BK病毒活化对移植肾功能的影响[J].中华器官移植杂志, 2013, 34(7):404-406. DOI: 10.3760/cma.j.issn.0254-1785.2013.07.006.

    WANG XY, FAN Y, HAN Y, et al. Influence of BK virus activation on the renal allograft function[J]. Chin J Organ Transplant, 2013, 34(7):404-406. DOI: 10.3760/cma.j.issn.0254-1785.2013.07.006.
    [11] WISEMAN AC. Polyomavirus nephropathy: a current perspective and clinical considerations[J]. Am J Kidney Dis, 2009, 54(1):131-142. DOI: 10.1053/j.ajkd.2009.01.271.
    [12] KNIGHT RJ, GABER LW, PATEL SJ, et al. Screening for BK viremia reduces but does not eliminate the risk of BK nephropathy: a single-center retrospective analysis[J]. Transplantation, 2013, 95(7):949-954. DOI: 10.1097/TP.0b013e31828423cd.
    [13] 范宇, 石炳毅, 钱叶勇, 等.尿液与血液病毒载量在肾移植受者BK病毒性肾病诊断中的应用[J].中华器官移植杂志, 2013, 34(10): 595-599. DOI: 10.3760/cma.j.issn.0254-1785.2013.10. 005.

    FAN Y, SHI BY, QIAN YY, et al. The cut-off value of BK virus DNA load in urine or plasma for diagnosis of BKVN in renal transplantation recipients[J]. Chin J Organ Transplant, 2013, 34(10): 595-599. DOI: 10.3760/cma.j.issn.0254-1785.2013.10.005.
    [14] JOHNSTON O, JASWAL D, GILL JS, et al. Treatment of polyomavirus infection in kidney transplant recipients: a systematic review[J]. Transplantation, 2010, 89(9):1057-1070. DOI: 10.1097/TP.0b013e3181d0e15e.
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出版历程
  • 收稿日期:  2019-01-13
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-05-15

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