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BK Virus-Nephropathie nach Nierentransplantation

BK virus nephropathy after renal transplantation

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Die BK-Virus-Nephropathie (BKVN) ist mit Prävalenzraten zwischen 1–9% mittlerweile eine der wichtigsten Ursachen für ein Transplantatversagen. Die BKVN tritt typischerweise innerhalb des ersten Jahres nach Nierentransplantation auf und führt in etwa 30% der Fälle zum Transplantatversagen. In der Pathogenese der BKVN spielen unterschiedliche Risikofaktoren wie Immunsuppression, patientenspezifische Charakteristika oder organsspezifische Faktoren eine Rolle. Die Mehrzahl der dokumentierten Fälle einer BKVN trat unter einer Kombinationstherapie von Tacrolimus und Mycophenolsäure auf. Durch Einsatz von Screeningverfahren, insbesondere innerhalb der ersten 2 Jahre nach Transplantation, kann auf der Basis einer frühzeitigen Modifikation der Immunsuppression der Übergang einer BKV-Replikation bzw. BKV-Infektion in eine manifeste BKV-Nephropathie in den meisten Fällen verhindert werden. Die derzeitigen therapeutischen Optionen umfassen neben der Modifikation der individuellen Immunsuppression in therapierefraktären Fällen den Off-label-Einsatz von Leflunomid bzw. Cidofovir.

Abstract

In the last decade, the prevalence of BK virus nephropathy has increased in renal transplant recipients and has become an important factor negatively influencing graft outcome. BK virus nephropathy typically occurs in the first year after renal transplantation and leads to allograft failure in about 30% of cases. The risk of BK virus infection is related to the overall load of immunosuppression, which is determined not only by immunosuppressive drugs but also by the recipient’s humoral and cellular immunity. In most cases, tacrolimus and mycophenolate are part of the immunosuppressive regimen. Reduction in immunosuppression at this time appears to be the best available approach for treating established BK virus nephropathy. Achieving a sufficient yet nontoxic immunosuppressive regimen remains a major problem in preventing renal transplant complications such as BK virus nephropathy.

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  1. Sektion Nephrologie, Medizinische Universitätsklinik Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Deutschland

    J. Beimler

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  1. J. Beimler
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Beimler, J. BK Virus-Nephropathie nach Nierentransplantation. Nephrologe 3, 14–21 (2008). https://doi.org/10.1007/s11560-007-0136-5

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  • DOI: https://doi.org/10.1007/s11560-007-0136-5

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