Miro J M, Ricart M J, Trullas J C, Cofan F, Cervera C, Brunet M, Tuset M, Manzardo C, Oppenheimer F, Moreno A
Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
Transplant Proc. 2010 Nov;42(9):3887-91. doi: 10.1016/j.transproceed.2010.09.003.
Since the introduction of combined antiretroviral therapy (cART), solid organ transplantation (SOT) has become a therapeutic option for the HIV-positive population. In contrast with liver and kidney transplantation, only three simultaneous pancreas-kidney transplants (SPKT) have been reported among HIV-infected patients. Herein we have reported the first SPKT in an HIV-infected patient in Spain. The pancreas graft failed at 2 weeks and the patient died at 9 months because of a Pseudomonas aeruginosa infection. The three recipients reported in the literature lived, despite the failure of both the pancreas and kidney grafts in one subject. Despite the poor outcome of our case, HIV-1 infection was controlled after transplantation (stable CD4(+) cells and no AIDS-related events), and the kidney graft functioned with no episodes of rejection. The cART regimen used in the pretransplant period was switched at the time of transplantation to raltegravir and two nucleoside reverse transcriptase inhibitors (NRTI). Raltegravir has no interactions with immunosuppressive drugs. Target plasma levels of tacrolimus were achieved at a dose similar to that used in HIV-negative transplant recipients. The most adequate antiretroviral regimen for HIV-infected SOT recipients has not yet been established; however, one may consider switching protease inhibitors or non-NRTI-based regimens for a raltegravir-based regimen at the time of transplantation.
自从联合抗逆转录病毒疗法（cART）问世以来，实体器官移植（SOT）已成为HIV阳性人群的一种治疗选择。与肝移植和肾移植不同，在HIV感染患者中仅报告了3例同期胰肾联合移植（SPKT）。在此，我们报告了西班牙首例HIV感染患者的SPKT。胰腺移植物在2周时失败，患者在9个月时因铜绿假单胞菌感染死亡。文献中报道的3例受者均存活，尽管其中1例受者的胰腺和肾移植物均失败。尽管我们的病例预后不佳，但移植后HIV-1感染得到了控制（CD4(+)细胞稳定且无艾滋病相关事件），肾移植物功能良好，无排斥反应发作。移植前使用的cART方案在移植时换用了拉替拉韦和两种核苷类逆转录酶抑制剂（NRTI）。拉替拉韦与免疫抑制药物无相互作用。他克莫司的目标血浆浓度在与HIV阴性移植受者使用的剂量相似的情况下得以实现。尚未确定针对HIV感染的SOT受者的最适宜抗逆转录病毒方案；然而，在移植时可考虑将蛋白酶抑制剂或非NRTI方案换为基于拉替拉韦的方案。
