The Mount Sinai Hospital, New York, New York.
Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, New York.
Clin Transplant. 2019 Jun;33(6):e13534. doi: 10.1111/ctr.13534. Epub 2019 Apr 3.
Rejection rates in HIV-infected kidney transplant (KTx) recipients are higher than HIV-negative recipients. Immunosuppression and highly active antiretroviral therapy (HAART) protocols vary with potentially significant drug-drug interactions, likely influencing outcomes. This is an IRB-approved, single-center, retrospective study of adult HIV-infected KTx patients between 5/2009 and 12/2014 with 3-year follow-up, excluding antibody-depleting induction. A total of 42 patients were included; median age was 52 years, 81% male, 50% African American, 29% Hispanic, 17% Caucasian. The most common renal failure etiology was hypertensive nephrosclerosis (50%) with 5.8 median years of pre-transplant dialysis. All patients received IL-2 receptor antagonist, were maintained on tacrolimus (76%) or cyclosporine (17%), and 40% received ritonavir-boosted PI-based HAART (rtv+) regimen. Patient and graft survival at 3 years were 93% and 90%. At 1-, 2-, and 3-year time points, median serum creatinine was 1.49, 1.35, and 1.67; treated biopsy-proven rejection was 38%, 38%, and 40.5%; and 92% of episodes were acute rejection. At these time points, rejection rates were significantly higher with boosted PI HAART regimens compared to other HAART regimens, 59% vs 24% (P = 0.029), 59% vs 24% (P = 0.029), and 68% vs 24% (P = 0.01). Despite higher rejection rates, HIV-infected KTx recipients have reasonable outcomes. Given significantly higher rejection rates using rtv+ regimens, alternative HAART regimens should be considered prior to transplantation.
在感染 HIV 的肾移植 (KTx) 受者中，排斥反应率高于 HIV 阴性受者。免疫抑制和高效抗逆转录病毒治疗 (HAART) 方案因潜在的显著药物相互作用而有所不同，可能会影响结果。这是一项经过机构审查委员会批准的、单中心、回顾性研究，纳入了 2009 年 5 月至 2014 年 12 月期间的成年 HIV 感染 KTx 患者，随访时间为 3 年，不包括抗体耗竭诱导。共有 42 名患者入组；中位年龄为 52 岁，81%为男性，50%为非裔美国人，29%为西班牙裔，17%为白人。最常见的肾衰竭病因是高血压性肾硬化 (50%)，移植前透析中位时间为 5.8 年。所有患者均接受白细胞介素-2 受体拮抗剂治疗，76%接受他克莫司，17%接受环孢素，40%接受利托那韦增强的 PI 为基础的 HAART（rtv+）方案。3 年时患者和移植物存活率分别为 93%和 90%。在 1、2 和 3 年时，中位血清肌酐分别为 1.49、1.35 和 1.67；经治疗的活检证实排斥反应分别为 38%、38%和 40.5%；92%的发作是急性排斥反应。在这些时间点，与其他 HAART 方案相比，使用 rtv+方案的排斥反应率显著更高，59%比 24%（P=0.029），59%比 24%（P=0.029），68%比 24%（P=0.01）。尽管排斥反应率较高，但感染 HIV 的 KTx 受者的结局仍较为合理。鉴于 rtv+方案的排斥反应率显著更高，在移植前应考虑替代 HAART 方案。
