Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA.
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Transpl Infect Dis. 2021 Jun;23(3):e13511. doi: 10.1111/tid.13511. Epub 2020 Dec 2.
Anti-Pneumocystis pneumonia (PCP) prophylaxis is recommended for 3 to 6 months post-transplant in HIV-negative kidney transplant recipients. For HIV-positive kidney transplant recipients, there is no definite duration of primary prophylaxis and is often prescribed life-long. The objective of this study was to determine the incidence of PCP in HIV-positive recipients who received 6 months of prophylaxis with trimethoprim-sulfamethoxazole or an alternative agent. One hundred and twenty-two HIV-positive recipients received a kidney transplant from 2001 to 2017 at Hahnemann University Hospital. Most patients received induction immunosuppression with an IL-2 receptor antagonist, with or without intravenous immunoglobulin. Only one patient received anti-thymocyte globulin. Maintenance immunosuppression included a calcineurin-inhibitor (tacrolimus or cyclosporine), an antiproliferative agent (mycophenolate or sirolimus), and prednisone. Mean CD4 cell count was 461 ± 127 cells/uL prior to transplant and 463 ± 229 cells/μL at 6 to 12 months after transplant. None of the recipients developed PCP after a median follow-up of 2.88 years (IQR 1.16-4.87). Based on our observation, a 6-month regimen of PCP prophylaxis may be sufficient among HIV-positive recipients, similar to those without HIV infection.
抗肺囊虫肺炎（PCP）预防建议在 HIV 阴性的肾移植受者移植后 3 至 6 个月进行。对于 HIV 阳性的肾移植受者，没有明确的原发性预防持续时间，通常是终身预防。本研究的目的是确定接受 6 个月复方磺胺甲噁唑或替代药物预防的 HIV 阳性受者中 PCP 的发生率。2001 年至 2017 年，Hahnemann 大学医院有 122 名 HIV 阳性受者接受了肾移植。大多数患者接受了白细胞介素-2 受体拮抗剂的诱导免疫抑制，有或没有静脉注射免疫球蛋白。只有 1 名患者接受了抗胸腺细胞球蛋白。维持性免疫抑制包括钙调神经磷酸酶抑制剂（他克莫司或环孢素）、抗增殖剂（霉酚酸酯或西罗莫司）和泼尼松。移植前平均 CD4 细胞计数为 461±127 个/μL，移植后 6 至 12 个月为 463±229 个/μL。在中位数为 2.88 年（IQR 1.16-4.87）的随访中，没有受者发生 PCP。根据我们的观察，6 个月的 PCP 预防方案可能足以预防 HIV 阳性受者，与未感染 HIV 的受者相似。
