Safety and success of kidney transplantation and concomitant immunosuppression in HIV-positive patients
Safety and success of kidney transplantation and concomitant immunosuppression in HIV-positive patients
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DOI：
10.1111/j.1523-1755.2005.00245.x
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发表时间：
2005-04-01
影响因子：
19.6
通讯作者：
Kumar, A
中科院分区：
文献类型：
--
作者：
Kumar, MSA;Sierka, DR;Kumar, A
背景人类免疫缺陷病毒相关性肾病（HIVAN）已成为非裔美国人终末期肾病（ESRD）的第三大原因，预计将呈指数增长。高效抗逆转录病毒治疗（HAART）显著延长了HIV感染患者的生存期。尽管越来越多的HIV阳性透析患者的预期寿命延长，但免疫抑制的肾移植已经下降，因为它被认为是由于潜在的发病率和死亡率增加而浪费稀缺的供体肾。德雷克塞尔大学医学院和哈内曼大学医院的机构审查委员会批准了这项前瞻性研究。目的是了解肾移植的安全性和成功率，以及免疫抑制对HIV感染的影响。2001年2月至2004年1月，40名艾滋病毒阳性透析患者接受了肾移植。患者入选标准为维持HAART、血浆HIV-1 RNA < 400拷贝/mL、绝对CD 4计数200个细胞/μ L或以上。免疫抑制是巴利昔单抗诱导和维持环孢霉素，西罗莫司和类固醇。移植后继续HAART。急性排斥反应通过活检诊断，并用甲基强的松龙治疗。在1、6、12和24个月时完成监测活检，并评估亚临床急性排斥反应、慢性移植物肾病和HIV。1年和2年的精确患者生存率分别为85%和82%，移植物生存率分别为75%和71%。血浆HIV-1 RNA仍然检测不到，CD 4计数仍然超过400个细胞/μ L，长达2年没有AIDS的证据。1年和2年移植物存活率与接受肾移植的其他高危人群相当。1年和2年患者生存率高于维持透析的HIV患者。免疫抑制不会在短期内对维持HAART的HIV接受者产生不利影响。
Background. Human immunodeficiency virus-associated nephropathy (HIVAN) has become the third leading cause of end-stage renal disease (ESRD) in African Americans, and is expected to grow exponentially. Highly active antiretroviral therapy (HAART) has significantly prolonged the survival of patients with HIV infection. Despite the growing number of HIV-positive dialysis patients with prolonged life expectancy, kidney transplantation with immunosuppression has been declined because it is considered a waste of scarce donor kidneys due to potential increases in morbidity and mortality.Methods. The institutional review board of Drexel University College of Medicine and Hahnemann University Hospital approved this prospective study. The aim was to find out safety and success of kidney transplantation, and the effect of immunosuppression on HIV infection. Forty HIV-positive dialysis patients received kidney transplantation between February 2001 and January 2004. Patient inclusion criteria were maintenance of HAART, plasma HIV-1 RNA of < 400 copies/mL, absolute CD4 counts of 200 cells/mu L or more. Immunosuppression was basiliximab induction and maintenance with cyclosporine, sirolimus, and steroids. HAART was continued post-transplant. Acute rejections were diagnosed by biopsy and treated with methylprednisolone. Surveillance biopsies were completed at 1, 6, 12, and 24 months, and evaluated for subclinical acute rejection, chronic allograft nephropathy, and HIVAN.Results. One- and 2-year actuarial patient survival was 85% and 82%, respectively, and graft survival was 75% and 71%, respectively. Plasma HIV-1 RNA remained undetectable, and CD4 counts remained in excess of 400 cells per mu L with no evidence of AIDS for up to 2 years.Conclusion. One- and 2-year graft survival is comparable to other high-risk populations receiving kidney transplantation. One- and 2-year patient survival is higher than HIV patients maintained on dialysis. Immunosuppression does not adversely affect HIV recipients maintained on HAART in the short term.