Roland M E, Barin B, Carlson L, Frassetto L A, Terrault N A, Hirose R, Freise C E, Benet L Z, Ascher N L, Roberts J P, Murphy B, Keller M J, Olthoff K M, Blumberg E A, Brayman K L, Bartlett S T, Davis C E, McCune J M, Bredt B M, Stablein D M, Stock P G
University of California, San Francisco, CA, USA.
Am J Transplant. 2008 Feb;8(2):355-65. doi: 10.1111/j.1600-6143.2007.02061.x. Epub 2007 Dec 18.
Improvements in human immunodeficiency virus (HIV)-associated mortality make it difficult to deny transplantation based upon futility. Outcomes in the current management era are unknown. This is a prospective series of liver or kidney transplant recipients with stable HIV disease. Eleven liver and 18 kidney transplant recipients were followed for a median of 3.4 years (IQR [interquartile range] 2.9-4.9). One- and 3-year liver recipients' survival was 91% and 64%, respectively; kidney recipients' survival was 94%. One- and 3-year liver graft survival was 82% and 64%, respectively; kidney graft survival was 83%. Kidney patient and graft survival were similar to the general transplant population, while liver survival was similar to the older population, based on 1999-2004 transplants in the national database. CD4+ T-cell counts and HIV RNA levels were stable; and there were two opportunistic infections (OI). The 1- and 3-year cumulative incidence (95% confidence intervals [CI]) of rejection episodes for kidney recipients was 52% (28-75%) and 70% (48-92%), respectively. Two-thirds of hepatitis C virus (HCV)-infected patients, but no patient with hepatitis B virus (HBV) infection, recurred. Good transplant and HIV-related outcomes among kidney transplant recipients, and reasonable outcomes among liver recipients suggest that transplantation is an option for selected HIV-infected patients cared for at centers with adequate expertise.
人类免疫缺陷病毒（HIV）相关死亡率的改善使得基于治疗无效而拒绝移植变得困难。当前管理时代的结果尚不清楚。这是一组前瞻性的肝脏或肾脏移植受者，他们患有稳定的HIV疾病。11例肝脏移植受者和18例肾脏移植受者被随访，中位随访时间为3.4年（四分位间距[IQR]为2.9 - 4.9年）。肝脏移植受者1年和3年生存率分别为91%和64%；肾脏移植受者生存率为94%。肝脏移植1年和3年移植物生存率分别为82%和64%；肾脏移植物生存率为83%。基于国家数据库中1999 - 2004年的移植情况，肾脏患者和移植物生存率与一般移植人群相似，而肝脏生存率与老年人群相似。CD4 + T细胞计数和HIV RNA水平稳定；有2例机会性感染（OI）。肾脏移植受者排斥反应发作的1年和3年累积发生率（95%置信区间[CI]）分别为52%（28 - 75%）和70%（48 - 92%）。三分之二的丙型肝炎病毒（HCV）感染患者复发，但乙型肝炎病毒（HBV）感染患者无复发。肾脏移植受者良好的移植和HIV相关结果，以及肝脏移植受者合理的结果表明，对于在具备足够专业知识的中心接受治疗的部分HIV感染患者，移植是一种选择。
