Cristelli Marina P, Cofán Federico, Tedesco-Silva Helio, Trullàs Joan Carles, Santos Daniel Wagner C L, Manzardo Christian, Agüero Fernando, Moreno Asunción, Oppenheimer Federico, Diekmann Fritz, Medina-Pestana Jose O, Miro Jose Maria
Hospital do Rim, UNIFESP, São Paulo, SP, Brazil.
Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
Transpl Infect Dis. 2017 Aug;19(4). doi: 10.1111/tid.12724. Epub 2017 Jun 26.
In the developed world, kidney transplantation (KT) in patients with human immunodeficiency virus (HIV) infection is well established. Developing countries concentrate 90% of the people living with HIV, but their experience is underreported. Regional differences may affect outcomes.
We compared the 3-year outcomes of patients with HIV infection receiving a KT in two different countries, in terms of incomes and development.
This was an observational, retrospective, double-center study, including all HIV-infected patients >18 years old undergoing KT.
Between 2005 and 2015, 54 KTs were performed (39 in a Brazilian center, and 15 in a Spanish center). Brazilians had less hepatitis C virus co-infection (5% vs 27%, P=.024). Median cold ischemia time was higher in Brazil (25 vs 18 hours, P=.001). Biopsy-proven acute rejection (AR) was higher in Brazil (33% vs 13%, P=.187), as were the number of AR episodes (22 vs 4, P=.063). Patient survival at 3 years was 91.3% in Brazil and 100% in Spain; P=.663. All three cases of death in Brazil were a result of bacterial infections within the first year post transplant. At 3 years, survival free from immunosuppressive changes was lower in Brazil (56% vs 90.9%, P=.036). Raltegravir-based treatment to avoid interaction with calcineurin inhibitor was more prevalent in Spain (80% vs 3%; P<.001). HIV infection remained under control in all patients, with undetectable viral load and no opportunistic infections.
Important regional differences exist in the demographics and management of immunosuppression and antiretroviral therapy. These details may influence AR and infectious complications. Non-AIDS infections leading to early mortality in Brazil deserve special attention.
在发达国家，人类免疫缺陷病毒（HIV）感染患者的肾移植（KT）已得到充分确立。发展中国家集中了90%的HIV感染者，但其经验报道不足。地区差异可能会影响治疗结果。
我们比较了两个不同国家中接受KT的HIV感染患者在收入和发展方面的3年治疗结果。
这是一项观察性、回顾性、双中心研究，纳入了所有年龄>18岁且正在接受KT的HIV感染患者。
2005年至2015年期间，共进行了54例KT（巴西中心39例，西班牙中心15例）。巴西患者丙型肝炎病毒合并感染较少（5%对27%，P = 0.024）。巴西的中位冷缺血时间较长（25小时对18小时，P = 0.001）。巴西活检证实的急性排斥反应（AR）较高（33%对13%，P = 0.187），AR发作次数也较高（22次对4次，P = 0.063）。巴西3年患者生存率为91.3%，西班牙为100%；P = 0.663。巴西的3例死亡均为移植后第一年内细菌感染所致。3年时，巴西无免疫抑制变化的生存率较低（56%对90.9%，P = 0.036）。西班牙更普遍采用基于雷特格韦的治疗以避免与钙调神经磷酸酶抑制剂相互作用（80%对3%；P<0.001）。所有患者的HIV感染均得到控制，病毒载量不可检测且无机会性感染。
在免疫抑制和抗逆转录病毒治疗的人口统计学和管理方面存在重要的地区差异。这些细节可能会影响AR和感染并发症。巴西导致早期死亡的非艾滋病感染值得特别关注。
