Bk virus enfeksiyonlu böbrek nakli alıcılarında azathiopürin tedavisinin etkinliğinin değerlendirilmesi
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Date
2018
Authors
Yavuz, Arda
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
BK virüs (BKV) böbrek nakilli hastalarda sık karşılaşılan bir patojendir. Potent immünsüpresyon hastalarda enfeksiyon sıklığında artış ile ilişkilidir. BKV enfeksiyonlu hastalarda başarısı kanıtlanmış tek tedavi yaklaşımı immünsüpresyonun azaltılmasıdır. Bu çalışmada; canlı ve kadaverik vericiden böbrek nakli yapılan ve BKV viremisi saptandıktan sonra mikofenolatın, azathioprine (AZA) ile değiştirildiği hastalarda tedavinin etkinliğinin ve yan etki profilinin değerlendirilmesi amaçlanmıştır.
Ocak 2010 - Mart 2018 tarihleri arasında böbrek nakli yapılan 25 hastanın (11 kadın, 14 erkek; ortanca yaş 45 yıl) verileri retrospektif olarak değerlendirildi. Alıcı ve vericilerin demografik özellikleri, alıcının diyaliz ve nakil bilgileri, eşlik eden hastalıklar, CMV enfeksiyonu öyküsü, immünsüpresif tedavi, BKV bilgileri ve nakil sonrası döneme ait laboratuvar test sonuçları medikal kayıtlardan elde edildi.
Nakil sonrası 1. ay düzeylerle karşılaştırıldığında, AZA geçişi sırasında ölçülen ortalama serum kreatinin düzeyleri anlamlı daha yüksek ve tahmini glomerüler filtrasyon hızı (GFH) değerleri anlamlı daha düşüktü. AZA geçişinde ölçülen serum kreatinin düzeyleri, AZA sonrası 1., 3., 6., 9., 12. ve 18.aylarda ölçülen ortalama kreatinin düzeylerinden farklı değildi. AZA geçişisonrası 1. ve 6. aylardaki medyan GFH değerleri, ilaç değişimi sırasında ölçülen GFH değerlerine göre anlamlı arttı. AZA geçişi sırasında ölçülen hemoglobin, lenfosit, sodyum, ürik asit ve albümin düzeyleri nakil sonrası 1. ay düzeylerine göre anlamlı daha yüksekti. AZA geçişi sırasında ölçülen ALT ve nötrofil düzeyleri, nakil sonrası 1. ay düzeyine göre anlamlı daha düşüktü. AZA geçişi sırasında ölçülen düzeyler ile karşılaştırıldığı zaman, 3. ayda hemoglobin, 6. ayda AST ve ALT, 3. ve 12. ayda albümin ile 1. ve 12. aylarda lökosit düzeyleri anlamlı azaldı. İlaç değişikliği sırasında ölçülen düzeylere göre, AZA sonrası 12. ayda trigliserid düzeyleri anlamlı artış gösterdi.
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Sonuç olarak BKV enfeksiyonu gelişen böbrek alıcılarında, mikofenolat tedavisi yerine AZA başlanması, kısa dönemde önemli bir yan etki yapmadan GFH değerlerini anlamlı arttırdı. Graft sağkalım sonuçlarımız benzer çalışma sonuçları ile uyumlu bulundu. Böbrek naklinde ilk kullanılan ajanlardan olan AZA, BKV nefropatisi gelişmesi durumunda etkin bir tedavi seçeneği olarak düşünülmelidir.
BK virus (BKV) is a common pathogen in kidney transplant patients. Potent immunosuppression is associated with increased frequency of infection in patients. The only successful proven treatment for BKV infection is reduction immunosuppression. The aim of this study was to evaluate the efficacy and side-effect profile of azathioprine (AZA) in patients, who was made kidney transplantation from a live or deceased donor then given azathioprine treatment from calcineurin inhibitors after BKV viremia was detected. The data of 25 patients (11 females, 14 males; median age 45 years) who underwent kidney transplantation between January 2010 and March 2018 were retrospectively evaluated. Demographic characteristics of the recipients, dialysis information of the recipients, transplantation information, concomittant diseases, CMV infection history, immunosuppressive therapy, BKV information, post-transplant laboratory test results were obtained from medical records. The mean serum creatinine levels measured were significant higher and estimated GFR values were lower during AZA switching when compared to the levels of first month after transplantation. Serum creatinine levels in AZA switching did not differ from the measured levels at 1st, 3rd, 6th, 9th, 12th and 18th months after AZA. The median GFR values at 1st and 6th months after AZA switching significantly increased compared to GFR values measured during drug change. Hemoglobin, lymphocyte, sodium, uric acid and albumin levels measured during AZA switching were significantly higher v than first month levels after transplantation. ALT and neutrophil levels measured at the time of AZA switching were significantly lower than the first month after transplantation. Hemoglobin at 3rd months, AST and ALT at 6th month, albumin at 3rd and 12th months, and leukocyte levels at 1st and 12th months significantly decreased when compared with the levels measured at the time of AZA switching. According to the levels measured during drug exchange, triglyceride levels increased significantly at 12th months after AZA. As a result, the initiation of AZA instead of mycophenolate therapy in kidney recipients with BKV infection significantly increased GFR values without significant side effects in the short-term. Our graft survival results were consistent with similar studies. AZA, one of the first agents used in kidney transplantation, should be considered as an effective treatment option in case of development of BKV nephropathy.
BK virus (BKV) is a common pathogen in kidney transplant patients. Potent immunosuppression is associated with increased frequency of infection in patients. The only successful proven treatment for BKV infection is reduction immunosuppression. The aim of this study was to evaluate the efficacy and side-effect profile of azathioprine (AZA) in patients, who was made kidney transplantation from a live or deceased donor then given azathioprine treatment from calcineurin inhibitors after BKV viremia was detected. The data of 25 patients (11 females, 14 males; median age 45 years) who underwent kidney transplantation between January 2010 and March 2018 were retrospectively evaluated. Demographic characteristics of the recipients, dialysis information of the recipients, transplantation information, concomittant diseases, CMV infection history, immunosuppressive therapy, BKV information, post-transplant laboratory test results were obtained from medical records. The mean serum creatinine levels measured were significant higher and estimated GFR values were lower during AZA switching when compared to the levels of first month after transplantation. Serum creatinine levels in AZA switching did not differ from the measured levels at 1st, 3rd, 6th, 9th, 12th and 18th months after AZA. The median GFR values at 1st and 6th months after AZA switching significantly increased compared to GFR values measured during drug change. Hemoglobin, lymphocyte, sodium, uric acid and albumin levels measured during AZA switching were significantly higher v than first month levels after transplantation. ALT and neutrophil levels measured at the time of AZA switching were significantly lower than the first month after transplantation. Hemoglobin at 3rd months, AST and ALT at 6th month, albumin at 3rd and 12th months, and leukocyte levels at 1st and 12th months significantly decreased when compared with the levels measured at the time of AZA switching. According to the levels measured during drug exchange, triglyceride levels increased significantly at 12th months after AZA. As a result, the initiation of AZA instead of mycophenolate therapy in kidney recipients with BKV infection significantly increased GFR values without significant side effects in the short-term. Our graft survival results were consistent with similar studies. AZA, one of the first agents used in kidney transplantation, should be considered as an effective treatment option in case of development of BKV nephropathy.
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Keywords
Böbrek nakli, Azathioprine, BK virüs, Graft sağkalımı, Kidney transplantation, Azathioprine, BK virus, Graft survival
Citation
Yavuz, A. (2018). Bk virus enfeksiyonlu böbrek nakli alıcılarında azathiopürin tedavisinin etkinliğinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.