HIV阳性患者接受亲属活体供肾移植一例及文献复习

HIV-positive patient receiving living related renal transplantation: a report of one case and literature review

目的探讨人类免疫缺陷病毒(HIV)阳性患者接受亲属活体供肾移植的临床诊治特点及其预后。方法回顾性分析1例接受亲属活体供肾移植的HIV阳性患者的临床资料,并复习相关文献。受者1年前因慢性肾功能不全行血液透析治疗,同时HIV筛查阳性并确诊感染后,接受正规高效联合抗反转录病毒治疗(HAART),治疗3个月后HIV RNA转阴。受者术前CD4+ T淋巴细胞计数为331个/μl,无机会性感染等并发症,群体反应性抗体(PRA)阴性。供者为受者母亲。受者术前使用巴利昔单抗及糖皮质激素行免疫诱导治疗,术后联合应用他克莫司、吗替麦考酚酯及糖皮质激素抗排斥反应治疗。结果移植手术顺利完成。术后第4天受者的血肌酐水平恢复正常。因他克莫司与抗逆转录病毒治疗方案中依非韦伦存在相互作用,受者血他克莫司浓度过低,给予提高他克莫司服用剂量直至0.2 mg·kg^-1·d^-1,并同时继续进行抗逆转录病毒治疗。随访1年,受者移植肾功能稳定,未出现移植物功能恢复延迟,未发生排斥反应和感染等并发症,复查未见HIV病毒复制。结论若HIV病毒得到控制,HIV阳性患者接受肾移植手术是可行、有效的,术后应注意免疫抑制剂与抗病毒药物间的相互作用。

Objective To summarize the outcomes and clinical experiences of renal transplantation in human immunodeficiency virus (HIV)-positive patients. Methods The clinical data were retrospectively analyzed for one HIV-positive case of renal transplantation. Diagnosed as chronic renal insufficiency 1 year ago, he received hemodialysis. After a positive screen for HIV, he received highly active antiretroviral therapy (HAART) and HIV RNA turned negative 3 months later. CD4+ T cell count was 331 cell/μl at pre-operation and there was no HIV-rated opportunistic infection or cancer. Her mother donated her kidney. Basiliximab and steroid pulse therapy were used preoperatively and immunosuppressants were used after transplantation, including tacrolimus, corticosteroids and mycophenolate mofetil. Results The kidney was transplanted successfully and serum creatinine declined to a normal level at day 4 after transplantation. Because of an interaction between efaverenz and tacrolimus, the blood concentration of tacrolimus was extremely low and the dose of tacrolimus had to be raised to 0.2 mg/(kg·d). Antiroviral therapy remained unchanged. No rejection and other complications were observed. And HIV RNA remained negative. Conclusions Renal transplantation is optimal for HIV-positive patients whose HIV status is completely under control. However, drug interactions needs to be considered during perioperative and postoperative periods.