Leflunomide Therapy in Kidney Transplantation: Ready for Prime Time?

[摘要] BK polyomavirus has become a scourge in kidney transplantation, mediating graft loss with progressive tubular cell death and interstitial inflammation and fibrosis (1). In the setting of immunosuppression, the virus reactivates, replicating along the tubular epithelium, spreading to other uninfected tubules, entering the tubular lumen after cell lysis, and eventually entering the bloodstream through destruction of peritubular capillaries (2). Whereas viruria is common, viremia occurs in only 13% of recipients, and nephropathy in 8% (3). Once a diagnosis is established by transplant biopsy and viral load measurements, the primary treatment strategy is immunousuppressive withdrawal (4). Disease that is more fully progressed may be unresponsive to any manipulation. Adjuvant therapies have included intravenous immune globulin, quinolones, and cidofovir, all with varying results (5). Center-specific experiences have been reported, but there are no definitive treatments.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome