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HIV患者的成功移植:路易斯安那州的经验。

Successful transplantation of HIV patients: the Louisiana experience.

作者信息

Hayes Kellen, Van Sickels Nicholas, Buell Joseph, Killackey Mary, Zhang Rubin, Slakey Douglas, Lukitsch Ivo, Alper Arnold, Mushatt David, Asad Shadaba, Paramesh Anil

机构信息

Tulane University School of Medicine, USA.

出版信息

J La State Med Soc. 2012 Jul-Aug;164(4):191-3.

Abstract

Human immunodeficiency virus (HIV) seropositivity has historically been an absolute contraindication for solid organ transplantation. However, the successful application of HAART (highly active anti-retroviral therapy) drug regimens has greatly prolonged the life expectancy of HIV-positive patients. Therefore, it has become appropriate to consider this patient population for transplantation. HIV positive transplants are being performed around the country in controlled settings, usually as part of a research protocol. The aim of our study is to describe the Louisiana experience with organ transplantation into HIV-positive patients. We identified seven HIV-positive patients who underwent kidney or kidney/pancreas transplantation at our center between 2007 and 2010. We performed a retrospective chart review to ascertain graft function, as well as virologic and immunologic status post-transplant. Renal function (glomerular filtration rate and serum creatinine concentrations) improved in all subjects post-transplant, and six of seven (85.8%) subjects remained virologically suppressed with no progression to Acquired Immunodeficiency Syndrome (AIDS). Overall, two-year graft and patient survival rates were 85.5%. HIV seropositive End Stage Renal Disease (ESRD) patients represent a new population of patients that can be successfully transplanted. This offers a new dimension in care for successful HAART therapy to prolong the life of HIV-infected patients.

摘要

从历史上看,人类免疫缺陷病毒(HIV)血清反应阳性一直是实体器官移植的绝对禁忌证。然而,高效抗逆转录病毒疗法(HAART)药物方案的成功应用极大地延长了HIV阳性患者的预期寿命。因此,考虑将这一患者群体纳入移植对象变得可行。目前全国各地都在可控的环境下为HIV阳性患者进行移植手术,通常作为研究方案的一部分。我们研究的目的是描述路易斯安那州在为HIV阳性患者进行器官移植方面的经验。我们确定了2007年至2010年间在我们中心接受肾脏或肾脏/胰腺移植的7名HIV阳性患者。我们进行了回顾性病历审查,以确定移植后的移植物功能以及病毒学和免疫学状况。所有受试者移植后的肾功能(肾小球滤过率和血清肌酐浓度)均有所改善,7名受试者中有6名(85.8%)病毒学得到抑制,未进展为获得性免疫缺陷综合征(AIDS)。总体而言,两年的移植物和患者生存率为85.5%。HIV血清反应阳性的终末期肾病(ESRD)患者代表了一类能够成功接受移植的新患者群体。这为通过成功的HAART疗法延长HIV感染患者的生命提供了新的护理层面。

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