Immunosuppression in HIV-positive kidney transplant recipients

Sorohan, Bogdan; Ismail, Gener; Leca, Nicolae

doi:10.1097/mot.0000000000001076

Cited by 2 publications

(1 citation statement)

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“…Living donors are less frequently seen than deceased donors in this category of patients, but offers by far a better graft survival rate [9,12]. Regarding immunosuppressive treatment, we used an IL2 receptor antagonist and methylprednisolone for induction and classical triple therapy with tacrolimus, mycophenolate, and prednisone for maintenance, according to current recommendations in patients living with HIV [14].…”

Section: Discussionmentioning

confidence: 99%

HIV and kidney transplantation in Romania: The index case

Sorohan,

Ismail,

Oprea

et al. 2024

Romanian Journal of Internal Medicine

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Introduction Human immunodeficiency virus (HIV) is no longer considered a contraindication for kidney transplantation (KT). KT management in HIV patients is a complex process with challenges, such as drug interactions between immunosuppression and antiretroviral (ARV) therapy. In our country, no KT has been performed thus far in this category of patients. Case presentation We present the case of a 29-year-old female patient with HIV and end-stage renal disease (ESRD) who performed a KT from a related living donor in March 2022. KT immediate evolution was favorable. No transplant-related complications were reported. HIV viral load remained undetectable and CD4+ T cells were constantly > 500 cell/ μL, during the 18 months of follow-up. The main challenge in our case was the drug interaction between the protease inhibitor-based regimen and tacrolimus. This led to tacrolimus overdose, and, subsequently, change in ARV therapy. ARV switching was performed on a regimen based on integrase inhibitor and nucleoside reverse transcriptase inhibitors. After the ARV change, the therapeutic level of tacrolimus was easily reached and maintained. Kidney graft function remained normal during follow-up, despite tacrolimus overexposure, and no rejection or anti-HLA antibodies were observed. Another challenge was related to the donor's hepatitis C virus status (positive antibodies, negative nucleic acid test). The recipient did not develop seroconversion or detectable viremia at 3-, 6-, 12- and 18-months post-KT. Conclusion We reported the first case of a successful KT in an ESRD patient with HIV in Romania, in whom the post-transplant evolution was favorable.

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Section: Discussionmentioning

confidence: 99%