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【文摘发布】来氟米特治疗移植肾多瘤病毒相关
Author：Faguer S, Hirsch HH, Kamar N, Guilbeau-Frugier C, Ribes D, Guitard J, Esposito L, Cointault O, Modesto A, Lavit M, Mengelle C, Rostaing L.
Source：Transpl Int. 2007 Jul 30; [Epub ahead of print]
Abstract：Polyomavirus-associated nephropathy (PVAN) affects 1-10% of kidney-transplant (KT) patients, with graft failure/loss in approximately 90% of cases. Reducing immunosuppression is the key treatment option, but addition of leflunomide may improve BK Virus (BKV) clearance and graft survival. In a prospective open-labeled study, 12 KT patients with biopsy-proven PVAN were treated with reduced immunosuppression and leflunomide. BKV viremia and graft function were followed. PVAN was diagnosed at 6 months (3-192) post-transplant; median serum creatinine concentration (sCC) was 189 mumol/l (92-265). After 16 months (8-30) of follow-up, the sCC was 150 mumol/l (90-378, NS). Renal function improved in six cases (50%), remained stable in two (16.6%) and deteriorated in four (33.4%), with graft loss in two (17%). Clearance of BKV viremia was observed in five (42%) cases. Side effects included anemia in six cases leading to leflunomide withdrawal in two patients, and mild thrombocytopenia. In KT patients diagnosed with PVAN, leflunomide plus reduced immunosuppression improved graft function in 66.6%, cleared BKV viremia in 42%, and resulted in side effects in 17%. This limited efficacy contrasts with other reports and falls short of expectation. We conclude that active screening, earlier diagnosis and intervention remain the cornerstones of treatment. Title：Leflunomide treatment for polyomavirus BK-associated nephropathy after kidney transplantation.
标题：来氟米特治疗移植肾多瘤病毒相关性肾炎
Author：Faguer S, Hirsch HH, Kamar N, Guilbeau-Frugier C, Ribes D, Guitard J, Esposito L, Cointault O, Modesto A, Lavit M, Mengelle C, Rostaing L.
Source：Transpl Int. 2007 Jul 30
Abstract：Polyomavirus-associated nephropathy (PVAN) affects 1-10% of kidney-transplant (KT) patients, with graft failure/loss in approximately 90% of cases. Reducing immunosuppression is the key treatment option, but addition of leflunomide may improve BK Virus (BKV) clearance and graft survival.
多瘤病毒相关性肾病危及1－10％的肾移植受者，移植肾失功的比例高达90％。减少免疫抑制剂是主要的治疗策略，但是加用来氟米特能有助于BK病毒的清除，提高移植物的存活率。
In a prospective open-labeled study, 12 KT patients with biopsy-proven PVAN were treated with reduced immunosuppression and leflunomide. BKV viremia and graft function were followed. PVAN was diagnosed at 6 months (3-192) post-transplant; median serum creatinine concentration (sCC) was 189 mumol/l (92-265). After 16 months (8-30) of follow-up, the sCC was 150 mumol/l (90-378, NS). Renal function improved in six cases (50%), remained stable in two (16.6%) and deteriorated in four (33.4%), with graft loss in two (17%). Clearance of BKV viremia was observed in five (42%) cases. Side effects included anemia in six cases leading to leflunomide withdrawal in two patients, and mild thrombocytopenia.
在一项前瞻性开放研究中，12例肾移植受者经肾组织活检证实为PVAN（多瘤病毒相关性肾病），通过减少免疫抑制治疗和加用来氟米特治疗，随访肾功能和血液中BKV的病毒负荷。PVAN在移植后6个月左右被诊断，平均血清肌酐浓度为189 mumol/l (92-265)。经过平均16个月（8－30月）的随访，平均sCC为150 mumol/l (90-378, NS).6例(50%)患者肾功能得到改善，2例(16.6%)患者维持在稳定水平，4例(33.4%)患者肾功能进一步恶化，其中2例(17%)移植物失功。5例(42%)患者血液中BK病毒被清除。副反应包括：6例患者出现贫血（其中2例患者因此而终止来氟米特）；轻度的血小板减少症。
In KT patients diagnosed with PVAN, leflunomide plus reduced immunosuppression improved graft function in 66.6%, cleared BKV viremia in 42%, and resulted in side effects in 17%. This limited efficacy contrasts with other reports and falls short of expectation. We conclude that active screening, earlier diagnosis and intervention remain the cornerstones of treatment.
在明确诊断PVAN的肾移植患者中，来氟米特联合免疫抑制剂减量能使66.6%的移植物功能得到改善，42％的患者血液中BK病毒被清除，副反应的发生率为17％。与既往的其他报道相比，本研究中治疗效果有限，但缺乏长期的观察。我们认为，积极的筛查，早期诊断和干预仍是最基本的治疗。
编译：
来氟米特治疗移植肾多瘤病毒相关性肾炎（441字）
多瘤病毒相关性肾病危及1－10％的肾移植受者，移植肾失功的比例高达90％。减少免疫抑制剂是主要的治疗策略，但是加用来氟米特能有助于BK病毒的清除，提高移植物的存活率。在一项前瞻性开放研究中，12例肾移植受者经肾组织活检证实为PVAN（多瘤病毒相关性肾病），通过减少免疫抑制治疗和加用来氟米特治疗，随访肾功能和血液中BKV的病毒负荷。
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作者:admin@医学,生命科学 2011-02-27 05:12
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