Immunosuppression in HIV-positive kidney transplant recipients.

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2023-08-01 Epub Date: 2023-05-23 DOI:10.1097/MOT.0000000000001076
Bogdan Marian Sorohan, Gener Ismail, Nicolae Leca
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Abstract

Purpose of study: The purpose of this review is to provide the current state of immunosuppression therapy in kidney transplant recipients (KTR) with HIV and to discuss practical dilemmas to better understand and manage these patients.

Recent findings: Certain studies find higher rates of rejection, which raises the need to critically assess the approach to immunosuppression management in HIV-positive KTR. Induction immunosuppression is guided by transplant center-level preference rather than by the individual patient characteristics. Earlier recommendations expressed concerns about the use of induction immunosuppression, especially utilizing lymphocyte-depleting agents; however, updated guidelines based on newer data recommend that induction can be used in HIV-positive KTR, and the choice of agent be made according to immunological risk. Likewise, most studies point out success with using first-line maintenance immunosuppression including tacrolimus, mycophenolate, and steroids. In selected patients, belatacept appears to be a promising alternative to calcineurin inhibitors with some well established advantages. Early discontinuation of steroids in this population carries a high risk of rejection and should be avoided.

Summary: Immunosuppression management in HIV-positive KTR is complex and challenging, mainly because of the difficulty of maintaining a proper balance between rejection and infection. Interpretation and understanding of the current data towards a personalized approach of immunosuppression could improve management in HIV-positive KTR.

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HIV 阳性肾移植受者的免疫抑制。
研究目的:本综述旨在介绍感染艾滋病毒的肾移植受者(KTR)的免疫抑制治疗现状,并讨论实际困境,以便更好地理解和管理这些患者:某些研究发现排斥反应发生率较高,因此有必要对 HIV 阳性 KTR 的免疫抑制管理方法进行严格评估。诱导免疫抑制的指导原则是移植中心的偏好,而不是患者的个体特征。早期的建议对诱导免疫抑制的使用表示担忧,尤其是使用淋巴细胞清除剂;然而,根据最新数据更新的指南建议,HIV 阳性 KTR 可以使用诱导免疫抑制,并根据免疫风险选择药物。同样,大多数研究指出,使用一线维持性免疫抑制剂(包括他克莫司、霉酚酸酯和类固醇)取得了成功。在选定的患者中,贝拉替塞似乎是钙调素酶抑制剂的一个很有前途的替代品,具有一些公认的优势。小结:HIV 阳性 KTR 的免疫抑制管理既复杂又具有挑战性,主要是因为很难在排斥反应和感染之间保持适当的平衡。解释和理解现有数据,采用个性化的免疫抑制方法,可以改善艾滋病病毒阳性 KTR 的管理。
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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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