Identification of Optimal Donor-Recipient Combinations Among Human Immunodeficiency Virus (HIV)-Positive Kidney Transplant Recipients
Identification of Optimal Donor-Recipient Combinations Among Human Immunodeficiency Virus (HIV)-Positive Kidney Transplant Recipients
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DOI：
10.1111/ajt.13847
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发表时间：
2016-08-01
影响因子：
8.8
通讯作者：
Segev, D. L.
中科院分区：
文献类型：
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作者：
Locke, J. E.;Shelton, B. A.;Segev, D. L.
对于某些患者亚组，人类免疫缺陷病毒（HIV）感染与肾移植（KT）后的不良结局相关;潜在的可变因素可能是原因。该研究的目的是确定HIV阳性KT受者与HIV阴性受者之间类似移植相比，预测移植失败风险更高的因素。在这项研究中，通过相互作用项分析研究了向移植受体科学登记处（SRTR）（2001-2013）报告的82 762例死亡供体KT受体（HIV阳性：526; HIV阴性：82 236）。与HIV阴性受者相比，HIV阳性KT受者中丙型肝炎病毒（HCV）的风险增加了2.72倍（校正风险比[aHR]：2.72，95%置信区间[CI]：1.75-4.22，p < 0.001）。43%的超额风险归因于HIV和HCV之间的相互作用（归因于相互作用的风险比例[AP]：0.43，95% CI：0.23-0.63，p = 0.02）。在HLA错配超过3次的HIV阳性受者中，风险是HIV阴性受者的1.80倍。（aHR：1.80，95%CI：1.31-2.47，p < 0.001）; 42%的超额风险归因于HIV与三种以上HLA亚型之间的相互作用。（AP：0.42，95% CI：0.24-0.60，p = 0.01）。高HIV风险（HIV阳性/HCV阳性HLA超过3个HLA）接受者的风险是低HIV风险（HIV阳性/HCV阴性HLA 3个或更少HLA）接受者的3.86倍（aHR：3.86，95%CI：2.37-6.30，p < 0.001）。在HIV阳性的KT受者中，特别是在合并感染的患者中，避免超过三个HLA错配，可能会减轻与HIV感染相关的移植物丢失的风险增加。在HIV感染的肾移植受者中，特别是在合并感染丙型肝炎的患者中，避免HLA错配，可能会减轻与HIV感染相关的移植物丢失的风险增加。
For some patient subgroups, human immunodeficiency virus (HIV) infection has been associated with worse outcomes after kidney transplantation (KT); potentially modifiable factors may be responsible. The study goal was to identify factors that predict a higher risk of graft loss among HIV-positive KT recipients compared with a similar transplant among HIV-negative recipients. In this study, 82 762 deceased donor KT recipients (HIV positive: 526; HIV negative: 82 236) reported to the Scientific Registry of Transplant Recipients (SRTR) (2001-2013) were studied by interaction term analysis. Compared to HIV-negative recipients, the hepatitis C virus (HCV) amplified risk 2.72-fold among HIV-positive KT recipients (adjusted hazard ratio [aHR]: 2.72, 95% confidence interval [CI]: 1.75-4.22, p < 0.001). Forty-three percent of the excess risk was attributable to the interaction between HIV and HCV (attributable proportion of risk due to the interaction [AP]: 0.43, 95% CI: 0.23-0.63, p = 0.02). Among HIV-positive recipients with more than three HLA mismatches (MMs), risk was amplified 1.80-fold compared to HIV-negative (aHR: 1.80, 95% CI: 1.31-2.47, p < 0.001); 42% of the excess risk was attributable to the interaction between HIV and more than three HLA MMs (AP: 0.42, 95% CI: 0.24-0.60, p = 0.01). High-HIV-risk (HIV-positive/HCV-positive HLAwith more than three MMs) recipients had a 3.86-fold increased risk compared to low-HIV-risk (HIV-positive/HCV-negative HLA with three or fewer MMs)) recipients (aHR: 3.86, 95% CI: 2.37-6.30, p < 0.001). Avoidance of more than three HLA MMs in HIV-positive KT recipients, particularly among coinfected patients, may mitigate the increased risk of graft loss associated with HIV infection.Avoidance of HLA mismatches in HIV-infected kidney transplant recipients, particularly among those coinfected with hepatitis C, may mitigate the increased risk of graft loss associated with HIV infection.