同种异体肾移植中多瘤病毒输尿管炎致移植输尿管狭窄2例报告并文献复习。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-07-01 DOI:10.1016/j.transproceed.2025.05.026

Tianlu Zhang , Qinyun Wu , Rongfang Shen , Wenhan Peng , Zhenpeng Jin , Sulin Luo , Luying Guo , Meifang Wang , Jianyong Wu , Jianghua Chen , Rending Wang

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引用次数: 0

摘要

背景：多瘤病毒输尿管炎是肾移植中一种罕见但越来越被认识到的并发症，有可能导致输尿管狭窄和移植物丢失。我们报告两例病理证实的多瘤病毒输尿管炎，表现为输尿管狭窄，通过输尿管膀胱再植手术和调整免疫抑制治疗成功治疗。病例介绍：第一个病例描述了一个41岁的男性肾移植受者，他表现为进行性肾积水，移植后5个月血清肌酐（Scr）水平升高308 μmol/L。第二例患者是一名25岁的女性受体，她在移植肾2个月后出现肾积水和输尿管上段扩张，随后Scr水平上升至167 μmol/L。尿检显示多瘤病毒载量高，而血病毒检测仍为阴性。输尿管活检经猴病毒40免疫组化染色证实为多瘤病毒输尿管炎。在输尿管膀胱再植手术成功并减少免疫抑制方案后，两名患者清除了尿液中的病毒，其Scr水平恢复到基线水平。结论：本报告强调输尿管多瘤病毒感染是肾移植受者输尿管狭窄病例的关键鉴别诊断。准确的诊断需要彻底的病理评估，包括输尿管组织的猴病毒40染色。早期识别和个体化治疗策略对于保持移植物功能和改善患者预后至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Transplant Ureteral Stenosis Caused by Polyomavirus Ureteritis in Allograft Kidney Transplantation: Two Cases Report and a Literature Review

Background

Polyomavirus ureteritis is a rare but increasingly recognized complication in kidney transplantation, with the potential to cause ureteral stenosis and graft loss. We report two pathologically confirmed cases of polyomavirus ureteritis presenting as ureteral stenosis, successfully treated with ureterovesical reimplantation surgery and adjustments in immunosuppressive therapy.

Case presentation

The first case describes a 41-year-old male renal transplant recipient, who presented with progressive hydronephrosis and an elevated serum creatinine (Scr) level of 308 μmol/L 5 months post-transplant. The second case involves a 25-year-old female recipient who developed hydronephrosis and dilatation of the upper ureter in the transplanted kidney 2 months post-transplant, with a subsequent rise in Scr level to 167 μmol/L. Urine tests revealed high polyomavirus loads, while blood viremia tests remained negative. Ureteral biopsy confirmed polyomavirus ureteritis through simian virus 40 immunohistochemical staining. Following successful ureterovesical reimplantation surgery and tailored reduction in immunosuppressive regimens, both patients cleared the virus in urine and their Scr levels returned to baseline.

Conclusion

This report highlights ureteral polyomavirus infection as a critical differential diagnosis in cases of ureteral stenosis among kidney transplant recipients. Accurate diagnosis requires thorough pathological evaluation, including simian virus 40 staining of ureteral tissue. Early recognition and individualized therapeutic strategies are essential to preserve graft function and improve patient outcomes.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.