University of Pennsylvania Comprehensive Transplant Center, Philadelphia, PA.
University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL.
Am J Transplant. 2017 Dec;17(12):3114-3122. doi: 10.1111/ajt.14419. Epub 2017 Aug 24.
Excellent outcomes have been demonstrated among select HIV-positive kidney transplant (KT) recipients with well-controlled infection, but to date, no national study has explored outcomes among HIV+ KT recipients by antiretroviral therapy (ART) regimen. Intercontinental Marketing Services (IMS) pharmacy fills (1/1/01-10/1/12) were linked with Scientific Registry of Transplant Recipients (SRTR) data. A total of 332 recipients with pre- and posttransplantation fills were characterized by ART at the time of transplantation as protease inhibitor (PI) or non-PI-based ART (88 PI vs. 244 non-PI). Cox proportional hazards models were adjusted for recipient and donor characteristics. Comparing recipients by ART regimen, there were no significant differences in age, race, or HCV status. Recipients on PI-based regimens were significantly more likely to have an Estimated Post Transplant Survival (EPTS) score of >20% (70.9% vs. 56.3%, p = 0.02) than those on non-PI regimens. On adjusted analyses, PI-based regimens were associated with a 1.8-fold increased risk of allograft loss (adjusted hazard ratio [aHR] 1.84, 95% confidence interval [CI] 1.22-2.77, p = 0.003), with the greatest risk observed in the first posttransplantation year (aHR 4.48, 95% CI 1.75-11.48, p = 0.002), and a 1.9-fold increased risk of death as compared to non-PI regimens (aHR 1.91, 95% CI 1.02-3.59, p = 0.05). These results suggest that whenever possible, recipients should be converted to a non-PI regimen prior to kidney transplantation.
在感染得到良好控制的情况下，选择的 HIV 阳性肾移植（KT）受者已经取得了良好的效果，但迄今为止，尚无全国性研究探讨过抗逆转录病毒疗法（ART）方案对 HIV+ KT 受者的影响。IMS 药房的配药记录（1/1/01-10/1/12）与 Scientific Registry of Transplant Recipients（SRTR）数据相关联。共有 332 名受者在移植前后均有配药，根据移植时的 ART 特征，分为蛋白酶抑制剂（PI）或非 PI 为基础的 ART（88 例 PI 与 244 例非 PI）。Cox 比例风险模型调整了受者和供者的特征。按 ART 方案比较受者，年龄、种族或 HCV 状态无显著差异。PI 为基础的方案组的受者，移植后预期生存（EPTS）评分>20%的比例显著更高（70.9%比 56.3%，p=0.02）。经调整分析，PI 为基础的方案与移植物丢失风险增加 1.8 倍相关（调整后的危险比[aHR]1.84，95%置信区间[CI]1.22-2.77，p=0.003），在移植后的第一年风险最大（aHR 4.48，95%CI 1.75-11.48，p=0.002），与非 PI 方案相比，死亡风险增加 1.9 倍（aHR 1.91，95%CI 1.02-3.59，p=0.05）。这些结果表明，只要有可能，受者在进行肾移植之前，应尽可能转换为非 PI 方案。
