First Canadian Case Report of Kidney Transplantation From an HIV-Positive Donor to an HIV-Positive Recipient.
First Canadian Case Report of Kidney Transplantation From an HIV-Positive Donor to an HIV-Positive Recipient.
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DOI：
10.1177/2054358117695792
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发表时间：
2017
影响因子：
1.7
通讯作者：
Rouleau D
中科院分区：
文献类型：
--
作者：
Ambaraghassi G;Cardinal H;Corsilli D;Fortin C;Fortin MC;Martel-Laferrière V;Malaise J;Pâquet MR;Rouleau D
在高度活跃的抗逆转录病毒治疗（HAART）时代，肾移植已成为精心挑选的人类免疫缺陷病毒（HIV）和终末期肾病（ESRD）患者的护理标准。美国和欧洲的前瞻性队列研究报告称，与艾滋病毒阴性肾移植受者相比，患者和移植物的存活率相似。尽管部分由于药物相互作用导致急性排斥反应发生率增加，但 HIV 免疫病毒学参数在免疫抑制期间通常仍处于控制之下。南非已开展了几例艾滋病毒感染者肾移植手术，并取得了良好的效果。加拿大此前尚未报道过艾滋病毒阳性捐献者进行肾移植的病例。一名 60 岁加拿大男子感染 HIV，于 2007 年出现与 IgA 肾病继发的急性肾功能衰竭相一致的症状。急性发作后导致慢性肾脏病。 2012 年开始进行血液透析。患者被转诊进行肾移植评估。该患者于 2016 年 1 月接受了 HIV 阳性捐赠者的肾移植。接受者的抗逆转录病毒治疗方案包括阿巴卡韦、拉米夫定和多替拉韦。这些抗逆转录病毒药物与所使用的维持免疫抑制方案之间没有药物相互作用的报道。移植后 7 个月的结果非常好，移植物功能良好，HIV 复制得到充分控制，在免疫抑制强度最高时没有机会性感染。没有急性排斥反应的报道。移植后成功治疗了由粪肠球菌引起的菌血症性移植物肾盂肾炎。通过仔细选择患者，艾滋病毒感染者之间的肾移植是一种可行的选择。使用无相互作用的抗逆转录病毒药物简化了免疫抑制药物的剂量和管理。
Kidney transplantation has become standard of care for carefully selected patients living with human immunodeficiency virus (HIV) and end-stage renal disease (ESRD) in the highly active antiretroviral therapy (HAART) era. American and European prospective cohort studies have reported similar patient and graft survival compared with HIV-negative kidney transplant recipients. Despite an increased rate of acute rejection, partially due to drug interactions, HIV immunovirologic parameter generally remains under control during immunosuppression. A few cases of kidney transplantation between HIV-infected patients were done in South Africa and showed favorable results. No cases of kidney transplantation from an HIV-positive donor in Canada have previously been reported. A 60-year-old Canadian man with HIV infection presented in 2007 with symptoms compatible with acute renal failure secondary to IgA nephropathy. Chronic kidney disease resulted after the acute episode. Hemodialysis was started in 2012. The patient was referred for a kidney transplantation evaluation. The patient underwent kidney transplantation from an HIV-positive donor in January 2016. The recipient’s antiretroviral regimen consisted of abacavir, lamivudine, and dolutegravir. No drug interactions have been reported between these antiretrovirals and the maintenance immunosuppressive regimen used. The outcome at 7 months post transplantation was excellent, with good graft function and adequate control of HIV replication, in the absence of opportunistic infections at a time when immunosuppression is at its highest intensity. No acute rejection was reported. An episode of bacteremic graft pyelonephritis due to Enterococcus faecalis was successfully treated after transplantation. With careful selection of patient, kidney transplantation between HIV-infected patients is a viable option. The use of antiretroviral drugs free of interactions simplified the dosing and management of the immunosuppressive drugs.