来氟米特用于抢救性治疗减免免疫抑制剂无效的肾移植术后BK病毒性肾病的体会:附4例报告

目的  探讨抢救性应用来氟米特治疗减免免疫抑制剂无效的肾移植术后BK病毒性肾病(BKVN)的临床体会。方法  4例肾移植术后BKVN受者,于术后第135~737日确诊,病理分期A1期2例、B1期1例、B2期1例。均在减免免疫抑制剂治疗0.5~3.0个月无效后,采用来氟米特抢救性治疗,先予50 mg/d连用3 d,达到有效治疗血药浓度后应用20 mg/d维持,观察其疗效及安全性。结果  经过平均6个月(5~7个月)的随访,有效控制BKVN进展者3例,无效者1例(B2期)。服药过程中未发生明显不良反应。结论  肾移植术后BKVN,在减免免疫抑制剂无效时,抢救性应用来氟米特有可能减缓BKVN进展,减少移植肾丢失的发生率。及早发现和诊断BKVN,力求病理学分期较早的情况下及时采取有效治疗措施效果较佳。

Experience with the application of leflunomide in rescuing therapy of BK virus nephropathy after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant:report of 4 cases

Objective To explore the clinical application experience of leflunomide in rescuing therapy of BK virus nephropathy (BKVN) after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant. Methods Four recipients with BKVN after renal transplantation were diagnosed at 135th-737th day after operation, with the pathological staging as following: 2 cases in stage A1, 1 case in stage B1 and 1 case in stage B2. For all recipients, leflunomide was used for rescuing therapy due to ineffective treatment with reduction of immunosuppressant for 0.5-3.0 months. Initially, 50 mg/d of leflunomide was given continuously for 3 days, so as to reach therapeutic serum concentration, and then 20 mg/d of leflunomide was given for maintaining. The efficacy and safety were observed. Results After a follow-up for an average of 6 months (5-7 months), 3 recipients with development of BKVN were controlled effectively, 1 recipient (stage B2) with ineffective treatment. No obvious adverse reactions occurred during medication. Conclusions It is possible to slow down the development of BKVN and reduce the incidence of renal allograft loss by using leflunomide to conduct rescuing therapy of BKVN after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant. Better effect can be achieved if early detection and diagnosis of BKVN are conducted as well as effective measures are taken timely in the early pathological stage.