Gruber Scott A, Doshi Mona D, Cincotta Elizabeth, Brown Kristian L, Singh Atul, Morawski Katherina, Alangaden George, Chandrasekar Pranatharthi, Losanoff Julian E, West Miguel S, El-Amm Jose M
Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI 48201, USA.
Transplantation. 2008 Jul 27;86(2):269-74. doi: 10.1097/TP.0b013e318177884e.
Only four centers have reported their results with renal transplantation in human immunodeficiency virus (HIV)+ recipients on highly active antiretroviral therapy, and acute rejection (AR) rates have consistently ranged from 43% to 67%.
We examined the outcomes of eight adult HIV+ primary renal allograft recipients with median 15 (range 8-47) months follow-up with multiple other high-risk factors, including African American ethnicity, hepatitis C virus (HCV) positivity, long waiting times, prior sensitization, paucity of live donors, and delayed graft function. Our immunosuppressive protocol consisted of an anti-interleukin-2 receptor antibody for induction, and mycophenolate mofetil, cyclosporin A, and prednisone for maintenance. Initial and 3- to 6-month cyclosporin A trough level targets were 250 to 300 and 225 to 275 ng/mL, respectively, and mycophenolate mofetil dose was adjusted according to 2 to 4 week surveillance and subsequent as needed mycophenolic acid predose concentrations during the first 6 months.
Patient and graft survival were 100% and 88%, respectively, with an AR rate of 13% and excellent renal function. No patients developed new-onset diabetes, opportunistic or other serious infections, malignancy, or progression of hepatitis C virus-related liver disease. Excellent suppression of HIV replication with maintenance of CD4 counts was noted in all cases.
Our findings suggest that HIV+ patients on highly active antiretroviral therapy can undergo successful renal transplantation with a low incidence of both AR and AIDS-associated and non-AIDS associated infections, despite associated risk factors for poorer outcome. Our encouraging but preliminary results with this protocol will need to be verified in larger numbers of HIV+ renal allograft recipients with longer follow-up.
仅有四个中心报告了在接受高效抗逆转录病毒治疗的人类免疫缺陷病毒（HIV）阳性受者中进行肾移植的结果，急性排斥反应（AR）率一直介于43%至67%之间。
我们研究了8例成年HIV阳性原发性肾移植受者的结局，随访时间中位数为15个月（范围8 - 47个月），这些受者还存在多种其他高危因素，包括非裔美国人种族、丙型肝炎病毒（HCV）阳性、等待时间长、既往致敏、活体供者稀缺以及移植肾功能延迟。我们的免疫抑制方案包括使用抗白细胞介素-2受体抗体进行诱导，以及使用霉酚酸酯、环孢素A和泼尼松进行维持治疗。初始及3至6个月时环孢素A谷浓度目标分别为250至300 ng/mL和225至275 ng/mL，霉酚酸酯剂量在前6个月根据2至4周的监测以及随后必要时的霉酚酸给药前浓度进行调整。
患者和移植肾存活率分别为100%和88%，AR率为13%，肾功能良好。无患者发生新发糖尿病、机会性感染或其他严重感染、恶性肿瘤或丙型肝炎病毒相关肝病进展。所有病例均观察到HIV复制得到良好抑制且CD⁺₄细胞计数维持稳定。
我们的研究结果表明，接受高效抗逆转录病毒治疗的HIV阳性患者能够成功进行肾移植，AR以及艾滋病相关和非艾滋病相关感染的发生率均较低，尽管存在预后较差的相关危险因素。我们采用该方案取得的令人鼓舞但尚属初步的结果，需要在更多HIV阳性肾移植受者中进行更长时间的随访来验证。
