Gathogo Esther N, Hamzah Lisa, Hilton Rachel, Marshall Neal, Ashley Caroline, Harber Mark, Levy Jeremy B, Jones Rachael, Boffito Marta, Khoo Saye H, Drage Martin, Bhagani Sanjay, Post Frank A
King's College London, London, UK.
Int J STD AIDS. 2014 Jan;25(1):57-66. doi: 10.1177/0956462413493266. Epub 2013 Jul 19.
HIV-positive patients are at increased risk of end-stage kidney disease (ESKD). Kidney transplantation (KT) is an established treatment modality for ESKD in the general population. Recent data have confirmed the feasibility of kidney transplantation in HIV-positive patients, and kidney transplantation is increasingly offered to ESKD patients with well-controlled HIV infection. We report clinical outcomes in a national cohort study of kidney transplantation in HIV-positive patients. In all, 35 HIV-positive KT recipients who had undergone KT up to December 2010 (66% male, 74% black ethnicity) were identified; the median CD4 cell count was 366, all had undetectable HIV RNA levels at kidney transplantation, and 44% received a kidney from a live donor. Patient survival at 1 and 3 years was 91.3%, and graft survival 91.3% and 84.7%, respectively. At one-year post-kidney transplantation, the cumulative incidence of acute rejection was 48%, and the median (IQR) eGFR was 64 (46, 78) mL/min/1.73 m(2). Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of kidney transplantation in HIV-positive patients. The high rates of acute rejection suggest that the optimal immune suppression strategy in this population remains to be refined.
HIV阳性患者发生终末期肾病（ESKD）的风险增加。肾移植（KT）是普通人群中ESKD的一种既定治疗方式。最近的数据证实了HIV阳性患者进行肾移植的可行性，并且越来越多地为HIV感染得到良好控制的ESKD患者提供肾移植。我们报告了一项关于HIV阳性患者肾移植的全国队列研究的临床结果。总共确定了35例截至2010年12月接受肾移植的HIV阳性肾移植受者（66%为男性，74%为黑人）；CD4细胞计数中位数为366，所有患者在肾移植时HIV RNA水平均检测不到，44%接受了活体供肾。1年和3年时的患者生存率分别为91.3%，移植肾生存率分别为91.3%和84.7%。肾移植后1年，急性排斥反应的累积发生率为48%，估算肾小球滤过率（eGFR）中位数（四分位间距）为64（46，78）mL/min/1.73m²。虽然HIV病毒血症和HIV疾病进展并不常见，但肾脏并发症相对频繁。我们的研究证实了HIV阳性患者进行肾移植的可行性。急性排斥反应的高发生率表明该人群的最佳免疫抑制策略仍有待完善。
