Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium.
Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium.
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DOI：
10.1016/j.lana.2023.100553
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发表时间：
2023-08
期刊：
影响因子：
--
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
Durand, Christine M.;Martinez, Nina;Neumann, Karl;Benedict, Reed C.;Baker, Arthur W.;Wolfe, Cameron R.;Stosor, Valentina;Shetty, Aneesha;Dietch, Zachary C.;Goudy, Leah;Callegari, Michelle A.;Massie, Allan B.;Brown, Diane;Cochran, Willa;Muzaale, Abimereki;Fine, Derek;Tobian, Aaron A. R.;Winkler, Cheryl A.;Al Ammary, Fawaz;Segev, Dorry L.
关键词：
根据《艾滋病毒器官政策公平法》(HOPE)的研究，美国艾滋病毒携带者(PLWH)可以进行活体肾脏捐赠。由于HIV相关的肾脏疾病和抗逆转录病毒疗法(ART)的肾毒性，供体肾切除可能会增加PLWH中终末期肾脏疾病(ESRD)的风险。在这里，我们报告了美国根据《希望法案》规定的首3例活体肾脏捐赠者感染艾滋病毒的病例。在希望行动多中心联盟的范围内，我们对携带艾滋病毒的活体肾脏捐赠者进行了一项前瞻性研究。在捐献前，我们估计了ESRD的9年累积发病率，进行了载脂蛋白L1(APOL1)的基因测试，排除了高危变异的个体，并进行了捐献前的肾脏活检(HOPE法案要求)。第一年的主要终点是≥3级肾切除术相关不良事件(AES)。捐献后，我们监测肾小球滤过率(用碘海醇/99mDTPA[mGFR]测量或用血清肌酐[EGFR]估计)、HIV RNA、CD4计数和ART。有三名捐赠者进行了2-4年的随访：一名35岁的女性，一名52岁的男性和一名47岁的男性。献血前9年ESRD累计发病率估计分别为3.01/万、8.01/万和7.76/万。在两名接受APOL1检测的捐赠者中，没有检测到高危变异。所有三名捐赠者的活组织检查都显示没有肾脏疾病。捐献后，两名捐赠者出现了与肾切除相关的≥3级AEs：一例是经医学处理的肠梗阻，另一例是经腹腔镜修复的切口疝。供者1的GFR在四年(MGFR)时从103降至84拷贝/分/1.73×10~2，供者2的GFR在三年(EGFR)时从77降至52拷贝/分/1.73×10~2，供者3的GFR在两年时从65降至39拷贝/分/1.73×10~2。所有供者的HIV RNA保持在20拷贝/毫升，CD4计数保持稳定。根据美国《希望法案》，前三位携带艾滋病毒的活体肾脏捐赠者在2-4年内取得了有希望的结果，为支持PLWH向艾滋病毒携带者进行活体捐赠提供了概念证明。、。
Living kidney donation is possible for people living with HIV (PLWH) in the United States within research studies under the HIV Organ Policy Equity (HOPE) Act. There are concerns that donor nephrectomy may have an increased risk of end-stage renal disease (ESRD) in PLWH due to HIV-associated kidney disease and antiretroviral therapy (ART) nephrotoxicity. Here we report the first 3 cases of living kidney donors with HIV under the HOPE Act in the United States. Within the HOPE in Action Multicenter Consortium, we conducted a prospective study of living kidney donors with HIV. Pre-donation, we estimated the 9-year cumulative incidence of ESRD, performed genetic testing of apolipoprotein L1 (APOL1), excluding individuals with high-risk variants, and performed pre-donation kidney biopsies (HOPE Act requirement). The primary endpoint was ≥grade 3 nephrectomy-related adverse events (AEs) in year one. Post-donation, we monitored glomerular filtration rate (measured by iohexol/Tc-99m DTPA [mGFR] or estimated with serum creatinine [eGFR]), HIV RNA, CD4 count, and ART. There were three donors with two-four years of follow-up: a 35 year-old female, a 52 year-old male, and a 47 year-old male. Pre-donation 9-year estimated cumulative incidence of ESRD was 3.01, 8.01, and 7.76 per 10,000 persons, respectively. In two donors with APOL1 testing, no high-risk variants were detected. Biopsies from all three donors showed no kidney disease. Post-donation, two donors developed nephrectomy-related ≥grade 3 AEs: a medically-managed ileus and a laparoscopically-repaired incisional hernia. GFR declined from 103 to 84 mL/min/1.73 m2 at four years (mGFR) in donor 1, from 77 to 52 mL/min/1.73 m2 at three years (eGFR) in donor 2, and from 65 to 39 mL/min/1.73 m2 at two years (eGFR) in donor 3. HIV RNA remained <20 copies/mL and CD4 count remained stable in all donors. The first three living kidney donors with HIV under the HOPE Act in the United States have had promising outcomes at two-four years, providing proof-of-concept to support living donation from PLWH to recipients with HIV. , .
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DOI：
10.1111/ajt.16205
发表时间：
2021-05
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Durand CM;Zhang W;Brown DM;Yu S;Desai N;Redd AD;Bagnasco SM;Naqvi FF;Seaman S;Doby BL;Ostrander D;Bowring MG;Eby Y;Fernandez RE;Friedman-Moraco R;Turgeon N;Stock P;Chin-Hong P;Mehta S;Stosor V;Small CB;Gupta G;Mehta SA;Wolfe CR;Husson J;Gilbert A;Cooper M;Adebiyi O;Agarwal A;Muller E;Quinn TC;Odim J;Huprikar S;Florman S;Massie AB;Tobian AAR;Segev DL;HOPE in Action Investigators
通讯作者：
HOPE in Action Investigators
影响因子：
6.2
作者：
Lentine KL;Kasiske BL;Levey AS;Adams PL;Alberú J;Bakr MA;Gallon L;Garvey CA;Guleria S;Li PK;Segev DL;Taler SJ;Tanabe K;Wright L;Zeier MG;Cheung M;Garg AX
通讯作者：
Garg AX
影响因子：
13.6
作者：
Kopp, Jeffrey B.;Nelson, George W.;Winkler, Cheryl A.
通讯作者：
Winkler, Cheryl A.
影响因子：
2.6
作者：
Grupper, Ayelet;Goykhman, Yaacov;Katchman, Eugene
通讯作者：
Katchman, Eugene
影响因子：
0.9
作者：
Katou, Shadi;Vogel, Thomas;Brockmann, Jens
通讯作者：
Brockmann, Jens