来自艾滋病毒感染者捐赠者的脏移植的安全性
Christine M Durand1, Allan Massie1, Sander Florman1
1From the Departments of Medicine (C.M.D., T.L., D.B., D.O., Y.E., F.N., A.D.R.), Surgery (N.D.), and Pathology (S.B., A.A.R.T.), Johns Hopkins University School of Medicine, Baltimore, the Department of Medicine, University of Maryland School of Medicine (J.B.), and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (N.W., E.B., J.O., A.D.R.) - all in Maryland; the Department of Population Health, New York University (NYU) Grossman School of Medicine (A.M., D.L.S.), the Recanati-Miller Transplantation Institute, Mount Sinai Hospital (S.F.), the Department of Medicine, Icahn School of Medicine at Mount Sinai (M.M.R.), NYU Langone Transplant Institute (S.A.M., D.L.S.), the Department of Medicine, Columbia University Irving Medical Center (M.R.P.), and the Department of Medicine, Weill Cornell Medicine (C.B.S.) - all in New York; the Department of Medicine, Emory University, Atlanta (R.F.-M.); the Department of Medicine, Georgetown University, Washington, DC (A.G.); the Department of Surgery, University of California, San Francisco, San Francisco (P.S.), the Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla (S. Aslam), and the Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles (J.S.) - all in California; the Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham (S.M.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine (V.S.), and the Division of Infectious Diseases, Rush University Medical Center (C.A.Q.S.) - both in Chicago; the Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (M.I.M.); the Department of Medicine, Ochsner Health, New Orleans (J.H.); the Section of Infectious Diseases, Yale School of Medicine, New Haven, CT (M.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (G.H.), and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania (E.A.B.), and the Department of Medicine, Drexel University College of Medicine (K.R.), Philadelphia - all in Pennsylvania; the Department of Medicine, University of Texas Southwestern Medical Center (D.W.), and the Department of Medicine, Methodist Health System Clinical Research Institute (J.A.C.-L.) - both in Dallas; the Department of Medicine, Indiana University Health, Indianapolis (O.A.); the Department of Surgery, Massachusetts General Hospital, Boston (N.E.); the Department of Surgery, University of Arkansas for Medical Sciences, Little Rock (E.G.); and the Department of Medicine, University of Cincinnati College of Medicine, Cincinnati (S. Apewokin).
从艾滋病毒携带的捐赠者向艾滋病毒携带的接受者进行脏移植是安全和有效的,与没有艾滋病毒携带的捐赠者进行的移植相比,显示出非劣势性. 这种新兴的做法为需要脏移植的HIV阳性个体提供了一个可行的选择.
科学领域:
- 移植免疫学 移植免疫学
- 传染性疾病 传染性疾病
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 从人类免疫缺陷病毒 (HIV) 阳性捐赠者到HIV阳性接受者进行移植是一种新兴的实践,已被批准用于研究.
- 目前的数据有限,促使人们考虑将其扩展到临床实践中.
研究的目的:
- 为了比较从已故的捐赠者与艾滋病毒感染者进行移植的安全性和有效性,与没有艾滋病毒感染者的捐赠者.
主要方法:
- 在26个美国中心进行的一项观察性研究比较了来自HIV阳性捐赠者和HIV阴性捐赠者的脏移植与HIV阳性接受者的脏移植.
- 主要结局是复合安全事件,评估非劣质性.
- 二级结局包括生存,移植损失,排斥,感染,癌症和艾滋病毒超级感染.
主要成果:
- 来自艾滋病毒感染者捐献者的脏移植与没有艾滋病毒的捐献者的脏移植无差 (针对安全事件的调整后危险比:1.00;95% CI,0.73至1.38).
- 整体存活率,没有移植损失的存活率和排斥率在1年和3年后的组之间是相似的.
- 严重不良事件,感染和癌症的发生率也相似,尽管艾滋病毒突破性感染在艾滋病毒供体组中更高.
结论:
- 来自艾滋病毒感染者捐赠者的脏移植似乎是艾滋病毒感染者接受者的安全和有效选择.
- 这项研究支持HIV-to-HIV脏移植在临床实践中的潜在扩展.
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