University of California, San Francisco, San Francisco, CA 94143-0470, USA.
Surgery. 2012 Sep;152(3):376-81. doi: 10.1016/j.surg.2012.06.012.
In this report, we examine the surgical safety and complications (SC) among 125 liver (L) and 150 kidney (K) HIV+ transplantation (TX) recipients in a prospective nonrandomized U.S. multicenter trial.
Subjects were required to have CD4+ T-cell counts >200/100 cells/mm3 (K/L) and undetectable plasma HIV-1 RNA (Viral Load [VL]) (K) or expected posttransplantation suppression (L). Impact of SCs (N ≥ 7) was evaluated by use of the proportional hazards models. Baseline morbidity predictors for SCs (N ≥ 7) were assessed in univariate proportional hazards models.
At median 2.7 (interquartile range 1.9-4.1) and 2.3 (1.0-3.7) years after TX, 3-month and 1-year graft survival were [K] 96% (95% CI 91%-98%) and 91% (95% CI 85%-94%) and [L] 91% (95% CI 85%-95%) and 77% (95% CI 69%-84%), respectively. A total of 14 K and 28 L graft losses occurred in the first year; 6 K and 11 L were in the first 3 months. A total of 26 (17%) K and 43 (34%) L experienced 29 and 62 SCs, respectively. In the liver multivariate model, re-exploration was marginally associated (hazard ratio [HR] 2.8; 95% CI 1.0-8.4; P = .06) with increased risk of graft loss, whereas a greater MELD score before transplantation (HR 1.07 per point increase; 95% CI: 1.01-1.14; P = .02), and detectable viral load before TX (HR 3.6; 95% CI 0.9-14.6; P = .07) was associated with an increased risk of wound infections/dehiscence.
The rates and outcomes of surgical complications are similar to what has been observed in the non-HIV setting in carefully selected HIV-infected liver and kidney TX recipients.
在这项报告中，我们研究了在一项美国多中心前瞻性非随机试验中，125 例肝（L）和 150 例肾（K）HIV+移植（TX）受者的手术安全性和并发症（SC）。
要求受试者的 CD4+T 细胞计数>200/100 个细胞/mm3（K/L），且血浆 HIV-1 RNA （病毒载量[VL]）（K）不可检测或预期移植后抑制（L）。使用比例风险模型评估 SCs（N≥7）的影响。在单变量比例风险模型中评估 SCs（N≥7）的基线发病率预测因子。
在 TX 后中位数为 2.7（四分位间距 1.9-4.1）和 2.3（1.0-3.7）年时，3 个月和 1 年的移植物存活率分别为[K]96%（95%CI 91%-98%）和 91%（95%CI 85%-94%）和[L]91%（95%CI 85%-95%）和 77%（95%CI 69%-84%）。第一年共发生 14 例 K 和 28 例 L 移植物丢失，其中 6 例 K 和 11 例 L 发生在第 3 个月内。共有 26（17%）例 K 和 43（34%）例 L 分别经历了 29 次和 62 次 SC。在肝多元模型中，再次探查（危险比[HR]2.8；95%CI 1.0-8.4；P=0.06）与移植物丢失风险增加相关，而移植前 MELD 评分更高（HR 每增加 1 分增加 1.07；95%CI：1.01-1.14；P=0.02），以及 TX 前可检测到的病毒载量（HR 3.6；95%CI 0.9-14.6；P=0.07）与伤口感染/裂开的风险增加相关。
在精心挑选的 HIV 感染肝和肾 TX 受者中，手术并发症的发生率和结果与非 HIV 环境中观察到的相似。
