Briner V, Zimmerli W, Cathomas G, Landmann J, Thiel G
Departemente für Innere Medizin und Chirurgie, Universitätskliniken Basel.
Schweiz Med Wochenschr. 1989 Jul 29;119(30):1046-52.
Since 1985 organ donors are routinely tested for the presence of HIV-antibodies, but prior to that time several patients acquired HIV-infection from grafts. In May 1984 a 65-year-old woman on hemodialysis received a cadaver kidney graft from a young iv drug addict. The transplant functioned perfectly with cyclosporin A immunosuppression. Retrospectively, 22 days after surgery HIV antigen was detected. At this time only a faint band of anti-p24 antibodies was found in the Western blot. Two years after surgery splenomegaly was found in the apparently healthy patient. During the third year thrombocytes fell and she developed lymphadenopathy and constitutional symptoms. Up to this time the immunological parameters were in the range of 10 healthy renal transplant patients with cyclosporin A treatment. In the 4th year T-lymphocytes dropped to values below 200 and the patient developed Pneumocystis carinii pneumonia. A few months later a pulmonary node, which later proved to be a B-cell lymphoma, appeared. Slightly less than 5 years after transplantation the patient died from clinically diagnosed pulmonary embolism. The progression of the HIV-Infection in this patient and in one of 18 patients in published reports show that the incubation period is several years shorter in renal transplant patients than in those who acquire HIV from blood products.
自1985年起，器官捐献者会定期接受HIV抗体检测，但在此之前，有几名患者因移植器官而感染了HIV。1984年5月，一名65岁的血液透析女性患者接受了一名年轻静脉吸毒者的尸体肾移植。在环孢素A免疫抑制治疗下，移植肾功能良好。回顾发现，术后22天检测到HIV抗原。此时，在蛋白质印迹法中仅发现一条微弱的抗p24抗体条带。术后两年，在这位看似健康的患者身上发现了脾肿大。在第三年，血小板数量下降，她出现了淋巴结病和全身症状。截至此时，其免疫参数与10名接受环孢素A治疗的健康肾移植患者的参数范围相同。在第四年，T淋巴细胞数量降至200以下，患者患上了卡氏肺孢子虫肺炎。几个月后，出现了一个肺结节，后来证实是B细胞淋巴瘤。移植后略少于5年，患者死于临床诊断的肺栓塞。该患者以及已发表报告中18名患者之一的HIV感染进展表明，肾移植患者的潜伏期比通过血液制品感染HIV的患者短数年。
