Current state of kidney transplantation in patients with HIV, hepatitis C, and hepatitis B infection

Sawinski, Deirdre; Wong, Tiffany; Goral, Simin

doi:10.1111/ctr.14048

Cited by 5 publications

(3 citation statements)

References 107 publications

(120 reference statements)

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“…Two of the three patients in this report were already co-infected with HBV. Although there is a fivefold increased risk of liver failure in HBV-positive recipients, there is no difference in the 5-year and graft survival compared to HBV-negative recipients [21,22]. Kidney transplantation for patients with HBV infection requires antiviral therapy before transplantation and lifelong treatment after surgery.…”

Section: Measures In Hepatitis Virus Co-infectionmentioning

confidence: 99%

Importance of multidisciplinary collaboration for smooth kidney transplantation in HIV-infected patients with chronic kidney disease: a case report

et al. 2022

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Background Antiretroviral therapy (ART) has reduced mortality caused by AIDS resulting from HIV infection. Meanwhile, the prevalence of chronic kidney disease, a chronic HIV complication, is increasing. Antiretroviral therapy has improved the life expectancy of HIV-infected kidney transplant recipients. In Japan, discrimination and prejudice against HIV persist, and few kidney transplants are performed. We report three cases in which kidney transplantation was smoothly performed with multidisciplinary collaboration. Case presentation The first case involved a 29-year-old male urgently hospitalized due to severe kidney dysfunction, diagnosed with HIV-associated nephropathy (HIVAN), and placed on maintenance dialysis. The patient was administered oral lamivudine, abacavir, and raltegravir as ART and underwent blood group-matched living donor kidney transplantation at age 32. The second case involved a 49-year-old male diagnosed as HIV-positive at age 33 and placed on maintenance dialysis for HIVAN at age 47. Darunavir, ritonavir, and dolutegravir (DTG) were initially administered. However, the ART was switched to rilpivirine (RPV) and DTG prior to kidney transplantation because of potential ART interactions with calcineurin inhibitors. The patient underwent blood group-matched living donor kidney transplantation. The third case involved a 41-year-old male diagnosed as HIV-positive at 23 years old and treated with RPV and DTG. Due to autosomal dominant polycystic kidney disease (ADPKD), his kidney function gradually worsened, and he was started on hemodialysis. He underwent hemodialysis, followed by blood type-matched living donor kidney transplantation. In all cases, transplant physicians, nephrologists, infectious disease physicians, hepatologists, nurses, pharmacists, nutritionists, and clinical psychologists collaborated to discuss and share medical problems and sociopsychological backgrounds of the patients. There was no rejection, CD4+ lymphocyte counts were maintained, and there was no increase in viral load post-surgery. Information sharing among various departments has continued post-surgery, kidney function has improved, and no increase in viral load has been identified on follow-up. Conclusions Kidney transplantation is the kidney replacement therapy of choice for HIV-infected patients with CKD. Specialized support is required for kidney transplantation, including coordinating immunosuppressive therapy to avoid rejection, learning about drug interactions, and providing sociopsychological support. Multidisciplinary collaboration is important to ensure safe and smooth kidney transplantation care for HIV-infected patients.

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Section: Measures In Hepatitis Virus Co-infectionmentioning

confidence: 99%

Importance of multidisciplinary collaboration for smooth kidney transplantation in HIV-infected patients with chronic kidney disease: a case report

et al. 2022

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“…10 Currently, the program has attained acceptance as the dominant strategy globally, even for patients with multi-morbidity status. 11 However, attaining kidney transplantation is also a challenge in many settings due to the shortage of organs, space, and technical capabilities. 12 Racial or ethnic disparities, as well as socioeconomic disparities, complicate its accessibility to minorities.…”

Section: Introductionmentioning

confidence: 99%

Providers’ View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present

Shimels

Getachew

Tadesse

et al. 2021

Health Services Research and Managerial Epidemiology

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Introduction: Transplantation is the optimal management for patients with end-stage renal disease. In Ethiopia, the first national kidney transplantation center was opened at St. Paul’s Hospital Millennium Medical College in September 2015. The aim of this study was to explore providers’ views and experiences of the past to present at this center. Methods: A qualitative study design was employed from 1st November to 15th December, 2019. To ensure that appropriate informants would provide rich study data, 8 health care providers and top management members were purposefully chosen for in-depth interviews. A maximum variation sampling method was considered to include a representative sample of informants. Interviews were digitally audio-recorded, and transcribed verbatim. Transcribed data was coded and analyzed using Qualitative Data Analysis (QDA) Minor Lite software and Microsoft-Excel. Result: The participants (5 males and 3 females) approached were from different departments of the renal transplant center, and the main hospital. Eight main themes and 18 sub-themes were generated initially from all interviews totaling to 109 index codes. Further evaluation and recoding retained 5 main themes, and 14 sub-themes. The main themes are; challenges experienced during and after launching the center, commitment, sympathy and satisfaction, outcomes of renal transplant, actions to improve the quality of service, and how the transplant center should operate. Providers claim that they discharge their responsibilities through proper commitment and compassion, paying no attention to incentive packages. They also explained that renal transplantation would have all the outcomes related to economic, humanistic and clinical facets. Conclusion and Recommendation: A multitude of challenges were faced during and after the establishment of the first renal transplant center in Ethiopia. Providers discharge their responsibility through a proper compassion for patients. Concerned stakeholders should actively collaborate to improve the quality of renal transplant services in the center.

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“…After control of HIV infection by antiretroviral therapy (ART), renal transplantation is the better treatment for ESRD, as compared to dialysis. HIV-positive patients generally have excellent patient and graft survival, similar to HIV- patients [2 ▪ ]. However, HIV-positive patients face a number of barriers to accessing renal transplantation, with the result that HIV-positive are less likely to be transplanted than HIV-negative.…”

Section: Introductionmentioning

confidence: 99%

HIV in kidney transplantation

Glicklich

Nog²

2021

Current Opinion in Organ Transplantation

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Purpose of reviewThe aim of this study was to describe recent developments in renal transplantation for HIV-positive recipients, especially the HIV Organ Policy Equity (HOPE) trial results. Recent findingsHOPE trial data show that HIV-positive Dþ/Rþ results are excellent and similar to DÀ/Rþ in patients controlled on antiretroviral therapy (ART). Patients coinfected with hepatitis C or B virus now have effective treatment available. As pretransplant evaluation and post-transplant management is more complex in HIVpositive individuals early referral is important and coordination of evaluation and care with an infectious disease specialist is critical. HIV coordinated care services should be involved for best outcomes. HIVpositive renal transplant recipients have an increased risk of rejection and evidence suggests that standard lymphocyte depletion induction and maintenance immunosuppression be employed. Cardiovascular risk reduction and surveillance and attention to metabolic bone disease are important for HIV-positive renal transplant recipients. SummaryHIV-positive to HIV-positive renal transplantation has been established as well tolerated and successful. Further efforts are needed to expand access to transplantation in this population.

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Current state of kidney transplantation in patients with HIV, hepatitis C, and hepatitis B infection

Cited by 5 publications

References 107 publications

Importance of multidisciplinary collaboration for smooth kidney transplantation in HIV-infected patients with chronic kidney disease: a case report

Importance of multidisciplinary collaboration for smooth kidney transplantation in HIV-infected patients with chronic kidney disease: a case report

Providers’ View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present

HIV in kidney transplantation

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