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第二个国际共识指南关于在移植中管理BK多重瘤病毒
Camille N Kotton1, Nassim Kamar2, David Wojciechowski3
1Transplant and Immunocompromised Host Infectious Diseases Unit, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Transplantation
|April 12, 2024
概括
在移植接受者中定期对BK多瘤病毒 (BKPyV) DNA进行查,对于早期检测和管理与BKPyV相关的病至关重要. 更新的指导方针建议在移植后的前9个月每月进行血BCPyV-DNAemia查.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 病毒学 病毒学
- 移植免疫学 移植免疫学
背景情况:
- 乙基多重瘤病毒 (BKPyV) 感染是造成移植异能和损失的重要原因.
- 识别风险因素和实施及时查对于预防BKPyV相关病 (BKPyVAN) 至关重要.
研究的目的:
- 审查当前的证据,并提供最新的国际专家建议,用于BKPyV查和脏移植接受者的管理.
- 建立基于证据的早期检测,风险分层和BKPyV感染治疗策略,以保护全移植功能.
主要方法:
- 系统地审查现有文献和专家共识会议,使用GRADE (推,评估,开发和评估的分级) 方法.
- 分析与BKPyV-DNAemia和活检证明的BKPyVAN相关的风险因素.
- 开发BKPyV感染的查协议和管理算法.
主要成果:
- BKPyV-DNAemia和BKPyVAN的主要危险因素包括接受者的年龄较大,男性性别,捐赠者BKPyV-病毒性病,特定的捐赠者/接受者血清状况,塔克罗利斯使用,急性排斥和高类固醇暴露.
- 在移植后9个月推每月进行血BCPyV-DNAemia查,然后每3个月进行一次,直到2岁 (3岁儿童).
- 尿细胞学可以在资源有限的环境中使用,在存在诱细胞时进行血BKPyV-DNAemia测试.
结论:
- 常规的,符合指导方针的BCPyV查具有成本效益,并改善了患者的治疗结果和生活质量.
- 降低免疫抑制是管理BKPyV-DNAemia或BKPyVAN的主要策略.
- 如果BKPyV-DNAemia无法检测到,BKPyVVAN后可以进行脏再移植;在临床试验中应进行实验性治疗.
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