Boyle Suzanne M, Malat Gregory, Harhay Meera N, Lee Dong H, Pang Lisa, Talluri Sindhura, Sharma Akshay, Bias Tiffany E, Ranganna Karthik, Doyle Alden M
Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Pharmacy, Hahnemann University Hospital, Philadelphia, PA, USA.
Transpl Infect Dis. 2017 Aug;19(4). doi: 10.1111/tid.12727. Epub 2017 Jul 28.
Tenofovir disoproxil fumarate (TDF) is an antiretroviral agent frequently used to treat human immunodeficiency virus (HIV). There are concerns regarding its potential to cause acute kidney injury, chronic kidney disease, and proximal tubulopathy. Although TDF can effectively suppress HIV after kidney transplantation, it is unknown whether use of TDF-based antiretroviral therapy (ART) after kidney transplantation adversely affects allograft survival.
We examined 104 HIV+ kidney transplant (KT) recipients at our center between 2001 and 2014. We generated a propensity score for TDF treatment using recipient and donor characteristics. We then fit Cox proportional hazards models to investigate the association between TDF treatment and 3-year, death-censored primary allograft failure, adjusting for the propensity score and delayed graft function (DGF).
Of the 104 HIV+ KT candidates who underwent transplantation during the study period, 23 (22%) were maintained on TDF-based ART at the time of transplantation, and 81 (78%) were on non-TDF-based ART. Median age of the cohort was 48 years; 87% were male; 88% were black; and median CD4 count at transplantation was 450 cells/mm . Median kidney donor risk index was 1.2. At 3 years post transplantation, primary allograft failure occurred in 26% of patients on TDF-based ART and in 28% of patients on non-TDF-based ART (P=.5). TDF treatment was not associated with primary allograft failure at 3 years post transplant after adjusting for DGF and a propensity score for TDF use (hazard ratio 2.12, 95% confidence interval 0.41-10.9).
In a large single-center experience of HIV+ kidney transplantation, TDF use following kidney transplantation was not significantly associated with primary allograft failure. These results may help inform management for HIV+ KT recipients in need of TDF therapy for adequate viral suppression.
富马酸替诺福韦二吡呋酯（TDF）是一种常用于治疗人类免疫缺陷病毒（HIV）的抗逆转录病毒药物。人们担心其有导致急性肾损伤、慢性肾病和近端肾小管病的可能性。虽然TDF在肾移植后能有效抑制HIV，但肾移植后使用基于TDF的抗逆转录病毒疗法（ART）是否会对移植肾存活产生不利影响尚不清楚。
我们研究了2001年至2014年间在我们中心接受肾移植的104例HIV阳性肾移植受者。我们根据受者和供者特征生成了TDF治疗的倾向评分。然后我们拟合Cox比例风险模型，以研究TDF治疗与3年死亡删失的原发性移植肾失功之间的关联，并对倾向评分和移植肾功能延迟恢复（DGF）进行校正。
在研究期间接受移植的104例HIV阳性肾移植候选者中，23例（22%）在移植时接受基于TDF的ART治疗，81例（78%）接受非TDF的ART治疗。该队列的中位年龄为48岁；87%为男性；88%为黑人；移植时的中位CD4细胞计数为450个/mm³。中位肾供者风险指数为1.2。移植后3年，接受基于TDF的ART治疗的患者中26%发生原发性移植肾失功，接受非TDF的ART治疗的患者中28%发生原发性移植肾失功（P = 0.5）。在对DGF和TDF使用倾向评分进行校正后，TDF治疗与移植后3年的原发性移植肾失功无关（风险比2.12，95%置信区间0.41 - 10.9）。
在一项大型单中心HIV阳性肾移植经验中，肾移植后使用TDF与原发性移植肾失功无显著关联。这些结果可能有助于为需要TDF治疗以充分抑制病毒的HIV阳性肾移植受者的管理提供参考。
