Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio.
Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
J Heart Lung Transplant. 2019 Dec;38(12):1296-1305. doi: 10.1016/j.healun.2019.09.011. Epub 2019 Sep 25.
Limited published data exist on outcomes related to heart and/or lung transplantation in human immunodeficiency virus (HIV)-infected individuals.
We conducted a multicenter retrospective study of heart and lung transplantation in HIV-infected patients and describe key transplant- and HIV-related outcomes.
We identified 29 HIV-infected thoracic transplant recipients (21 heart, 7 lung, and 1 heart and/or lung) across 14 transplant centers from 2000 through 2016. Compared with an International Society for Heart and Lung Transplantation registry cohort, we demonstrated similar 1-, 3-, and 5-year patient and allograft survivals for each organ type with a median follow up of 1,064 (range, 184-3,745) days for heart and 1,540 (range, 116-3,206) days for lung recipients. At 1 year, significant rejection rates were high (62%) for heart transplant recipients (HTRs). Risk factors for rejection were inconclusive, likely because of small numbers, but may be related to cautious early immunosuppression and infrequent use of induction therapy. Pulmonary bacterial infections were high (86%) for lung transplant recipients (LTRs). Median CD4 counts changed from baseline to 1 year from 399 to 411 cells/µl for HTRs and 638 to 280 cells/µl for LTRs. Acquired immunodeficiency syndrome-related events, including infections and malignancies, were rare. Rates of severe renal dysfunction suggest a need to modify nephrotoxic anti-retrovirals and/or immunosuppressants.
HIV-infected HTRs and LTRs have similar survival rates to their HIV-uninfected counterparts. Although optimal immunosuppression is not defined, it should be at least as aggressive as that for HIV-uninfected recipients. Such data may help pave the way for the use of hearts and lungs from HIV-infected donors in HIV-infected recipients through HIV Organ Policy Equity Act protocols.
有关艾滋病毒（HIV）感染者心脏和/或肺移植相关结局的已发表数据有限。
我们进行了一项多中心回顾性研究，纳入了 HIV 感染者的心肺移植病例，并描述了关键的移植和 HIV 相关结局。
我们在 2000 年至 2016 年间从 14 个移植中心确定了 29 例 HIV 感染的胸科移植受者（21 例心脏，7 例肺，1 例心脏和/或肺）。与国际心肺移植协会注册队列相比，我们发现每种器官类型的 1 年、3 年和 5 年患者和移植物存活率相似，心脏受者的中位随访时间为 1064 天（范围 184-3745 天），肺受者的中位随访时间为 1540 天（范围 116-3206 天）。在第 1 年，心脏移植受者（HTRs）的排斥反应发生率很高（62%）。排斥反应的风险因素尚无定论，这可能是因为病例数较少，但可能与早期免疫抑制谨慎和诱导治疗不频繁有关。肺移植受者（LTRs）的肺部细菌感染发生率很高（86%）。HTRs 的 CD4 计数从基线到第 1 年从 399 个/µl 增加到 411 个/µl，LTRs 的 CD4 计数从 638 个/µl 增加到 280 个/µl。获得性免疫缺陷综合征相关事件，包括感染和恶性肿瘤，很少见。严重肾功能障碍的发生率表明需要调整肾毒性抗逆转录病毒药物和/或免疫抑制剂。
HIV 感染的 HTRs 和 LTRs 的存活率与未感染 HIV 的受者相似。尽管尚未确定最佳的免疫抑制方案，但它至少应与未感染 HIV 的受者一样积极。这些数据可能有助于为使用 HIV 感染者的心脏和肺通过 HIV 器官政策公平法案协议在 HIV 感染者中铺平道路。
