Solid Organ Transplantation for HIV-Infected Individuals.
Solid Organ Transplantation for HIV-Infected Individuals.
复制标题
DOI：
10.1007/s40506-018-0144-1
复制
发表时间：
2018-03
影响因子：
2
通讯作者：
Durand CM
中科院分区：
文献类型：
--
作者：
Shaffer AA;Durand CM
艾滋病毒感染者（HIV+）中终末期器官疾病的患病率正在增加。接受抗逆转录病毒治疗（ART）的HIV控制良好的个体，没有活动性机会性感染或癌症，并且具有指定的最低CD 4细胞计数，是合适的移植候选人。传染病临床医生可以改善这些患者接受移植的机会，并优化移植前后的管理。临床试验和基于登记的研究表明，选择的HIV+肾和肝移植受者具有与HIV未感染患者相似的患者和移植物存活率。在HIV+个体中观察到移植物排斥率升高;这可能与免疫系统失调或药物相互作用有关。使用国家登记数据，淋巴细胞耗竭免疫抑制与较低的排斥率相关，而不会增加感染。丙型肝炎病毒（HCV）合并感染与更差的结局相关，但预期直接作用的抗病毒药物会改善。实体器官移植应考虑为艾滋病毒+个人与终末期器官疾病。传染病临床医生可以优化ART以避免与免疫抑制相互作用的药物增强剂。HCV治疗的时间（移植前或移植后）应与移植团队讨论。最后，在研究方案范围内，现在可以考虑将来自艾滋病毒+捐赠者的器官用于艾滋病毒+移植候选人。
The prevalence of end-stage organ disease is increasing among HIV-infected (HIV+) individuals. Individuals with well-controlled HIV on antiretroviral therapy (ART), without active opportunistic infections or cancer, and with specified minimum CD4 cell counts are appropriate transplant candidates. Infectious disease clinicians can improve access to transplantation for these patients and optimize management pre- and post-transplant. Clinical trials and registry-based studies demonstrate excellent outcomes for select HIV+ kidney and liver transplant recipients with similar patient and graft survival as HIV-uninfected patients. Elevated allograft rejection rates have been observed in HIV+ individuals; this may be related to a dysregulated immune system or drug interactions. Lymphocyte-depleting immunosuppression has been associated with lower rejection rates without increased infections using national registry data. Hepatitis C virus (HCV) coinfection has been associated with worse outcomes, however improvements are expected with direct-acting antivirals. Solid organ transplantation should be considered for HIV+ individuals with end-stage organ disease. Infectious disease clinicians can optimize ART to avoid pharmacoenhancers, which interact with immunosuppression. The timing of HCV treatment (pre- or post-transplant) should be discussed with the transplant team. Finally, organs from HIV+ donors can now be considered for HIV+ transplant candidates, within research protocols.