目的 探讨不同免疫抑制剂方案对长期存活的肾移植患者肝肾功能及血糖、血脂代谢的影响.方法 收集2020年7月1日至2021年4月1日期间来吉林大学第一医院随访且存活10年以上功能稳定的肾移植患者临床血液标本,共计291例,根据不同免疫抑制方案对其进行分组,他克莫司(tacrolimus,FK)组、环孢素A(cyclosporin A,CSA)组、西罗莫司(sirolimus,SRL)组,分别进行肝肾功能、血糖血脂检测并登记各指标.结果 FK组、CSA组、SRL组中ALT、TP、UA、TC、TG、LDL-C差异有统计学意义(P<0.05).结论 不同的免疫抑制方案对长期生存肾移植术后患者肝肾功能、血糖影响不大,主要影响其脂类代谢.

Objective:To summarize the incidence, treatment and prognosis of BK virus (BKV) infection in renal transplant recipients.Methods:The clinical data of recipients who underwent renal transplantation in the First Hospital of Jilin University from December 2015 to December 2018 and were regularly followed up and monitored for BKV infection were retrospectively analyzed to observe the incidence of each stage of BKV infection and the therapeutic effect and outcome.Results:As of June 2019, the median follow-up time of 629 renal transplant recipients was 16 months. The incidence of BK viruria was 24.5% (154/629), and the detection time was (5.3±5.0) months after surgery; the incidence of BK viremia was 7.5% (47/629), and the detection time was (8.2±7.4) months after surgery; the incidence of BK virus nephropathy (BKVN) was 4.3% (27/629), the detection time was (14.5±8.4) months after surgery, and the incidence of renal allograft failure was 1.9% (12/629). The incidence of BKV infection is high within 12 months after renal transplantation. Among the 154 recipients with BK viruria after renal transplantation, 30 recipients with low-level BK viruria were treated with a close follow-up monitoring regimen, and 124 recipients with high-level BKV urination were treated with a rapid dose reduction regimen of immunosuppressive agents; 35.7% (55/154) had a decrease in urine BKV DNA load to a low level, 23.4% (36/154) had a negative urine BKV, 24.7% (38/154) had a persistently high urine BKV DNA load, 8.4% (13/154) progressed to BK viremia, 7.8% (12/154) progressed to BKVN, and no renal allograft failure occurred. Among the 47 recipients with BK viremia after renal transplantation, 44 were treated with immunosuppressant conversion regimen and 3 with immunosuppressant rapid dose reduction regimen; 55.3% (26/47) had negative serum BKV, 31.9% (15/47) progressed to BKVN, and 12.8% (6/47) had persistently positive serum BKV. All 27 BKVN recipients after renal transplantation were treated with immunosuppressant conversion+ antiviral treatment therapy; 63.0% (17/27) had negative serum BKV, 22.2% (6/27) had persistently positive serum BKV, all had abnormal renal allograft function, and 14.8% (4/27) had renal allograft failure.Conclusions:The incidence of BKV infection is high at 1-year after renal transplantation. Regular screening of BKV during this period is of great significance for early detection of infection and preemptive treatment.

Objective:To investigate the clinical significance of regular monitoring of BK virus (BKV) infection on the prognosis of BK virus nephropathy (BKVN) after renal transplantation.Methods:Thirty-six renal transplant recipients with pathologically confirmed BKVN from 2015 to 2018 in our center were selected as the research objects. According to their BKV monitoring, the recipients were divided into active monitoring group (15 cases) and passive discovery group (21 cases). The detection time of BKV urination and blood, BKVDNA load, time to diagnosis of BKVN, serum and urine BKV conversion after treatment and renal allograft function were observed in the two groups.Results:The detection time of BKV, BKV and BKVN was (5.3±3.4) months, (7.8±3.8) months and (10.3±7.4) months, respectively. There were significant differences in the proportion of recipients with serum BKV conversion (14/15 and 11/21) and urine BKV conversion (12/15 and 10/21) in the passive monitoring group after treatment (χ2=0.029 and 0.012, P<0.05). The time of urine BKV conversion in the subjective monitoring group was (3.3±3.2) months after treatment, and the time of serum BKV conversion was (0.8±0.7) months after treatment, which were earlier than those in the passive discovery group [(5.6±2.1) months and (3.6±2.1) months], and the differences were statistically significant (t=0.041 and 0.027, all P<0.05). The proportion of recipients who developed renal allograft failure/insufficiency was lower in the active monitoring group (4/15) than in the passive discovery group (13/21), and the difference was statistically significant (χ2=0.015, P<0.05).Conclusions:Active and regular monitoring of BKV after renal transplantation is helpful for early diagnosis of BKVN, increasing the proportion of BKV conversion, shortening the time of BKV conversion and reducing the occurence of renal allograft failure.