BK virus nephropathy (BKVN) is increasingly recognized as a major cause of renal allograft failure. Recent reports demonstrate that prompt reduction of immunosuppression upon detection of persistent viremia can be associated with resolution of viremia, with minimal risk of acute rejection (AR). However, these experiences in general have occurred in centers with low baseline risks of AR. It is possible that a finer balance between overimmunosuppression and the risk of AR may exist in centers that routinely transplant patients with higher risk of AR. Thus the risk/benefit of this strategy may be altered in these centers. We report a case of antibody-mediated rejection that followed reduction of immunosuppression for BKVN diagnosed more than 3 months after the onset of viremia. This rejection episode resulted in a greater decrease in graft function than the initial BKVN episode. Issues relevant to the management of these patients are discussed, including the need for improved immune monitoring assays to determine more accurately the balance between infection and rejection.

译文

:BK病毒性肾病(BKVN)被越来越多地认为是同种异体肾功能衰竭的主要原因。最近的报道表明,检测到持续的病毒血症后,免疫抑制的迅速降低可与病毒血症的消退相关,而急性排斥反应(AR)的风险最小。但是,这些经验通常发生在AR基线风险较低的中心。在常规移植AR风险较高的患者的中心中,过度免疫抑制和AR风险之间可能存在更好的平衡。因此,在这些中心可以改变这种策略的风险/利益。我们报告了一例抗体介导的排斥反应,随后在病毒血症发作后3个月内诊断为BKVN的免疫抑制降低。与最初的BKVN发作相比,该排斥发作导致移植物功能的下降更大。讨论了与这些患者的治疗有关的问题,包括需要改进免疫监测方法以更准确地确定感染和排斥反应之间的平衡。

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