Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Johns Hopkins Medical Center, Baltimore, Maryland, USA.
Transpl Infect Dis. 2024 Aug;26(4):e14287. doi: 10.1111/tid.14287. Epub 2024 May 2.
Kidney transplantation has a survival benefit for people with human immunodeficiency virus (HIV) and end-stage kidney disease, however increased rates of rejection remain an issue. Questions remain regarding the impact of induction immunosuppression therapy and antiretroviral (ARV) choice on long-term outcomes.
We performed a multicenter retrospective analysis of outcomes in recipients with HIV who received kidneys from donors without HIV transplanted between 2004 and 2019. The association between induction and ARV regimens and long-term outcomes including rejection, graft, and recipient survival over 5 years was investigated using Cox regression modeling.
Seventy-eight kidney transplants (KT) performed in 77 recipients at five US transplant centers were included, with median follow up of 7.1 (4.3-10.7) years. Overall recipient and graft survival were 83% and 67%, respectively. Rejection occurred in 37% (29/78). Recipients with rejection were more likely to be younger, recipients of deceased donor organs, and Black. Receipt of rabbit anti-thymocyte globulin (rATG) induction without protease-inhibitor (PI)-based ARVs was associated with 83% lower risk of rejection (adjusted hazard ratio (aHR) 0.17 (95% CI 0.05-0.63), p =.007) and a non-statistically significantly lower risk of graft failure (aHR 0.18 (0.03-1.16), p =.07) when compared to those who received other induction and ARV combinations.
In this multicenter retrospective study, we found a trend toward lower rejection and improved graft survival among those who received both rATG for induction and PI-sparing ARVs.
肾移植可提高人类免疫缺陷病毒（HIV）合并终末期肾病患者的生存率，但排斥反应的发生率仍居高不下。目前仍存在一些问题，例如诱导免疫抑制治疗和抗逆转录病毒（ARV）药物选择对长期结果的影响。
我们对 2004 年至 2019 年间接受无 HIV 供体肾移植的 HIV 感染者的多中心回顾性研究结果进行了分析。采用 Cox 回归模型，研究诱导和 ARV 方案与 5 年内排斥反应、移植物和受者存活率等长期结果之间的关系。
共纳入来自美国 5 个移植中心的 77 名患者的 78 例肾移植，中位随访时间为 7.1（4.3-10.7）年。总体受者和移植物存活率分别为 83%和 67%。排斥反应发生率为 37%（29/78）。发生排斥反应的受者更年轻、接受的是已故供者器官、且为黑人。与接受其他诱导和 ARV 联合方案相比，接受兔抗胸腺细胞球蛋白（rATG）诱导而未接受蛋白酶抑制剂（PI）为基础的 ARV 治疗的受者，其排斥反应的风险降低 83%（调整后的危险比（aHR）0.17（95%CI 0.05-0.63），p=0.007），移植失败的风险降低 83%（aHR 0.18（0.03-1.16），p=0.07）。
在这项多中心回顾性研究中，我们发现，与接受其他诱导和 ARV 联合方案相比，同时接受 rATG 诱导和 PI 节约型 ARV 治疗的患者排斥反应发生率更低，移植物存活率更高。
