Jose M Miro, Nerea L Amondarain, Lucia Serrano, Jon Salmanton-Garcia, Christian Manzardo, Daniela Malano-Barletta, David Paredes-Zapata, Antonio Guerra-Maio, Jean-Paul Stahl, Marta Subirana, Pablo Ruiz, Constantino Fondevila, Federic Cofán, Angela González, Mireia Musquera, Beatriz Mahillo, Gloria de la Rosa, Rosario Marazuela, Antonio Rimola, Asuncion Moreno
{"title":"欧洲hiv阳性供体向hiv阳性受体实体器官移植的现状。西班牙视角。","authors":"Jose M Miro, Nerea L Amondarain, Lucia Serrano, Jon Salmanton-Garcia, Christian Manzardo, Daniela Malano-Barletta, David Paredes-Zapata, Antonio Guerra-Maio, Jean-Paul Stahl, Marta Subirana, Pablo Ruiz, Constantino Fondevila, Federic Cofán, Angela González, Mireia Musquera, Beatriz Mahillo, Gloria de la Rosa, Rosario Marazuela, Antonio Rimola, Asuncion Moreno","doi":"10.1016/j.cmi.2025.08.025","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>There is limited information on the use of organs from HIV-positive donors (HIV D+) for HIV-positive recipients (HIV R+) in Europe. In some countries the use of HIV D+ organs is prohibited by law. This study aimed to assess the attitudes of Spanish kidney and liver transplant (KT/LT) teams towards HIV D+/R+ KT/LT through a nationwide survey, and to evaluate the current situation across Europe regarding legislation and reported cases.</p><p><strong>Methods: </strong>In 2018 and 2019, two surveys were conducted across Spain's 24 LT and 39 KT centres, respectively. Specialists in HIV/infectious diseases, nephrology/hepatology, urology/liver surgery and transplant coordination completed a questionnaire, with responses analysed by speciality. We also consulted European representatives on national legal frameworks regarding HIV D+/R+ and conducted a narrative review of published cases (2000-2025).</p><p><strong>Results: </strong>The Spanish survey was answered by at least one member of all Spanish LT and KT teams (63/63, 100%). Most specialists who responded to the survey (167/252; 66%) supported using organs from HIV D+ virologically suppressed (VS) on ART, high-risk and serodiscordant couples, but not from non-VS HIV D+, for HIV R+. All respondents endorsed implementing a dedicated consent form, and a majority expressed willingness to participate in an HIV D+/R+ trial. No major differences were observed between LT and KT teams. At the European level, the use of organs from HIV D+ was permitted, prohibited or unregulated in 6 (17%), 11 (31.5%) and 18 (51.5%) countries, respectively. Ten HIV D+/R+ transplants (six kidneys and four livers) have been published, with good one-year outcomes.</p><p><strong>Conclusions: </strong>The surveyed Spanish specialists would agree on using organs from VS HIV D+ for HIV D+/R+ transplants. This procedure is only legally allowed in very few European countries. 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引用次数: 0
摘要
目的：在欧洲，关于将HIV阳性供体（HIV D+）的器官用于HIV阳性受者（HIV R+）的信息有限。在一些国家，法律禁止使用HIV +器官。本研究旨在通过一项全国性调查，评估西班牙肾脏和肝脏移植（KT/LT）团队对HIV D+/R+ KT/LT的态度，并评估整个欧洲关于立法和报告病例的现状。方法：2018年和2019年，分别在西班牙24家LT和39家KT中心进行了两次调查。艾滋病毒/传染病、肾脏病学/肝病学、泌尿学/肝脏外科和移植协调方面的专家填写了一份调查表，并按专业对答复进行了分析。我们还就有关艾滋病毒D+/R+的国家法律框架咨询了欧洲代表，并对已发表的病例（2000-2025年）进行了叙述性审查。结果：西班牙的调查至少有一名西班牙LT和KT团队的成员回答（63/ 63,100%）。大多数接受调查的专家（167/252;66%）支持使用抗逆转录病毒治疗中HIV D+病毒学抑制（VS）、高危和血清不一致夫妇的器官，但不支持使用非VS HIV D+的器官来治疗HIV R+。所有受访者都赞同实施专门的同意书，大多数人表示愿意参加艾滋病毒D+/R+试验。LT和KT团队之间没有明显的差异。在欧洲一级，分别有6个（17%）、11个（31.5%）和18个（51.5%）国家允许、禁止或不管制使用来自HIV D+的器官。10例HIV D+/R+移植（6例肾脏和4例肝脏）已经公布，一年的预后良好。结论：接受调查的西班牙专家同意使用VS HIV D+器官进行HIV D+/R+移植。这种手术只在极少数欧洲国家被合法允许。这些结果应该会促进整个欧洲对捐赠法的改变。
Current Situation of Solid Organ Transplantation from HIV-Positive Donors to HIV-Positive Recipients in Europe. The Spanish Perspective.
Objectives: There is limited information on the use of organs from HIV-positive donors (HIV D+) for HIV-positive recipients (HIV R+) in Europe. In some countries the use of HIV D+ organs is prohibited by law. This study aimed to assess the attitudes of Spanish kidney and liver transplant (KT/LT) teams towards HIV D+/R+ KT/LT through a nationwide survey, and to evaluate the current situation across Europe regarding legislation and reported cases.
Methods: In 2018 and 2019, two surveys were conducted across Spain's 24 LT and 39 KT centres, respectively. Specialists in HIV/infectious diseases, nephrology/hepatology, urology/liver surgery and transplant coordination completed a questionnaire, with responses analysed by speciality. We also consulted European representatives on national legal frameworks regarding HIV D+/R+ and conducted a narrative review of published cases (2000-2025).
Results: The Spanish survey was answered by at least one member of all Spanish LT and KT teams (63/63, 100%). Most specialists who responded to the survey (167/252; 66%) supported using organs from HIV D+ virologically suppressed (VS) on ART, high-risk and serodiscordant couples, but not from non-VS HIV D+, for HIV R+. All respondents endorsed implementing a dedicated consent form, and a majority expressed willingness to participate in an HIV D+/R+ trial. No major differences were observed between LT and KT teams. At the European level, the use of organs from HIV D+ was permitted, prohibited or unregulated in 6 (17%), 11 (31.5%) and 18 (51.5%) countries, respectively. Ten HIV D+/R+ transplants (six kidneys and four livers) have been published, with good one-year outcomes.
Conclusions: The surveyed Spanish specialists would agree on using organs from VS HIV D+ for HIV D+/R+ transplants. This procedure is only legally allowed in very few European countries. These results should promote changes in donor laws across Europe.
期刊介绍：
Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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