抗逆转录病毒治疗（HAART）下 HIV 阳性受者的肾移植。12 个系列的综合回顾和荟萃分析。

Kidney transplants in HIV-positive recipients under HAART. A comprehensive review and meta-analysis of 12 series.

机构信息

Transplant Surgery Division, University Hospital La Fe, Av. Campanar 21, 46009 Valencia, Spain.

出版信息

Nephrol Dial Transplant. 2010 Sep;25(9):3106-15. doi: 10.1093/ndt/gfq125. Epub 2010 Mar 11.

DOI:10.1093/ndt/gfq125

PMID:20228071

Abstract

BACKGROUND

Kidney transplantation is being introduced gradually for the treatment of end-stage renal disease in patients who are human immunodeficiency virus (HIV) positive. Our aim was to review the outcomes of kidney transplantation in HIV-positive recipients who were being treated with highly active antiretroviral therapy (HAART).

METHODS

Eligible papers were English language manuscripts, published between July 2003 and April 2009 and available through Medline, that described three or more recipients of kidney transplants who were HIV positive and undergoing HAART. The regimens for induction and maintenance therapy, organ rejection, patient survival, CD4 counts, HIV progression, infectious complications and deaths were recorded. The survival at 1 year, organ rejection and infectious complications were evaluated using a random effects model with 95% confidence intervals (CI).

RESULTS

Twelve case series met the defined criteria. Induction therapy consisted most commonly of the administration of anti-CD25 monoclonal antibodies, and triple immunosuppressive therapy was used most commonly for maintenance. Among the 254 patients, 1-year survival was 0.93 (95% CI, 0.90-0.96), organ rejection was diagnosed in 0.36 (95% CI, 0.25-0.49) and infectious complications occurred in 0.29 (95% CI, 0.17-0.43). The CD4 counts decreased after transplantation but recovered later. Acquired immune deficiency syndrome (AIDS)-defining infections occurred in three patients.

CONCLUSIONS

Kidney transplantation appears to be safe in patients undergoing HAART. However, larger series of patients are needed to determine the best protocols for the induction and maintenance of immunosuppression.

摘要

背景

对于接受高效抗逆转录病毒治疗（HAART）的人类免疫缺陷病毒（HIV）阳性终末期肾病患者，正在逐步引入肾移植作为治疗方法。我们的目的是回顾接受肾移植的 HIV 阳性受者的结果，这些受者正在接受 HAART 治疗。

方法

合格的论文是英文手稿，发表于 2003 年 7 月至 2009 年 4 月之间，并可通过 Medline 获得，这些论文描述了 3 名或 3 名以上接受肾移植且正在接受 HAART 的 HIV 阳性受者。记录了诱导和维持治疗、器官排斥、患者存活、CD4 计数、HIV 进展、感染性并发症和死亡的方案。使用具有 95％置信区间（CI）的随机效应模型评估了 1 年生存率、器官排斥和感染性并发症。

结果

有 12 项病例系列符合定义的标准。诱导治疗最常使用抗-CD25 单克隆抗体，最常使用三联免疫抑制治疗维持治疗。在 254 名患者中，1 年生存率为 0.93（95％CI，0.90-0.96），诊断为器官排斥的患者为 0.36（95％CI，0.25-0.49），发生感染性并发症的患者为 0.29（95％CI，0.17-0.43）。移植后 CD4 计数下降，但后来恢复。3 名患者发生了获得性免疫缺陷综合征（AIDS）定义的感染。