Immunosuppression Regimen and the Risk of Acute Rejection in HIV-Infected Kidney Transplant Recipients

Locke, Jayme E.; James, Nathan T.; Mannon, Roslyn B.; Mehta, Shikha; Pappas, Peter G.; Baddley, John W.; Desai, Niraj M.; Montgomery, Robert A.; Segev, Dorry L.

doi:10.1097/01.tp.0000436905.54640.8c

Cited by 83 publications

(107 citation statements)

References 26 publications

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“…Our experience concurs with that of Tan et al who treated three HIV-positive recipients of live-donor renal allografts with alemtuzumab (30mg, plus short term glucocorticoids) and tacrolimus maintenance immunosuppression, reporting no acute rejection, opportunistic infections or malignancy during median follow up of 39 months [8]. A further 29 HIV positive patients received a renal transplant with alemtuzumab induction therapy up to 2011 in the United States although complications such as opportunistic infections and malignancy were was not reported [4]. Our data suggest that the clinical utility of alemtuzumab in HIV positive kidney transplant recipients warrants further investigation, especially in those at high immunological risk of AR or when glucocorticoid-sparing, low-intensity calcineurin inhibitor exposure is desirable.…”

Section: Casesupporting

confidence: 74%

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Alemtuzumab induction therapy in HIV-positive renal transplant recipients

Mclean

Gathogo

Goodall

et al. 2017

Aids

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Section: Casesupporting

confidence: 74%

“…However, the incidence of acute allograft rejection (AR) remains high [4], with 31-48% of patients experiencing an episode of AR in the first year [1,5]. The use of tacrolimus, a more potent calcineurin inhibitor than ciclosporin, has been associated with a reduced risk of AR [1,6].…”

mentioning

confidence: 99%

Alemtuzumab induction therapy in HIV-positive renal transplant recipients

Mclean

Gathogo

Goodall

et al. 2017

Aids

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“…The Annual Data Report describes early post-transplant outcomes, including graft failure and function. Many researchers have used OPTN data to examine determinants of important outcomes after kidney transplantation, including death, graft failure, DGF, and acute rejection (2)(3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Validating Early Post–Transplant Outcomes Reported for Recipients of Deceased Donor Kidney Transplants

Potluri

Parikh

Hall

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Data reported to the Organ Procurement and Transplantation Network (OPTN) are used in kidney transplant research, policy development, and assessment of center quality, but the accuracy of early post-transplant outcome measures is unknown.Design, setting, participants, & measurements The Deceased Donor Study (DDS) is a prospective cohort study at five transplant centers. Research coordinators manually abstracted data from electronic records for 557 adults who underwent deceased donor kidney transplantation between April of 2010 and November of 2013. We compared the post-transplant outcomes of delayed graft function (DGF; defined as dialysis in the first posttransplant week), acute rejection, and post-transplant serum creatinine reported to the OPTN with data collected for the DDS.Results Median kidney donor risk index was 1.22 (interquartile range [IQR], 0.97-1.53). Median recipient age was 55 (IQR, 46-63) years old, 63% were men, and 47% were black; 93% had received dialysis before transplant. Using DDS data as the gold standard, we found that pretransplant dialysis was not reported to the OPTN in only 11 (2%) instances. DGF in OPTN data had a sensitivity of 89% (95% confidence interval [95% CI], 84% to 93%) and specificity of 98% (95% CI, 96% to 99%). Surprisingly, the OPTN data accurately identified acute allograft rejection in only 20 of 47 instances (n=488; sensitivity of 43%; 95% CI, 17% to 73%). Across participating centers, sensitivity of acute rejection varied widely from 23% to 100%, whereas specificity was uniformly high (92%-100%). Six-month serum creatinine values in DDS and OPTN data had high concordance (n=490; Lin concordance correlation =0.90; 95% CI, 0.88 to 0.92).Conclusions OPTN outcomes for recipients of deceased donor kidney transplants have high validity for DGF and 6-month allograft function but lack sensitivity in detecting rejection. Future studies using OPTN data may consider focusing on allograft function at 6 months as a useful outcome.

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“…The results of this study prompted us to encourage living donor renal transplantation, and we opted to use tacrolimus and basiliximab (rather than antithymocyte globulin for induction therapy) together with corticosteroids and MMF. We decided not to use mTOR-inhibitors as their use has been associated with a higher risk for viral-driven cancers10 and recent experience with their use in HIV-positive adult renal transplant recipients has shown a higher incidence of antibody-mediated rejection compared with calcineurin inhibitors 11…”

Section: Discussionmentioning

confidence: 99%

Successful outcome of renal transplantation in a child with HIV-associated nephropathy

Shroff

McCulloch

Novelli

et al. 2014

Archives of Disease in Childhood

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Classical HIV-associated nephropathy (HIVAN) was first described before the advent of highly active antiretroviral therapy in late stages of HIV disease with high viral load and low CD4 cell count. Renal transplantation has been successful in a large series of carefully selected HIV-infected adults, with patient and renal allograft survival approaching those of non-HIV-infected patients. We report the successful outcome of living related renal transplantation in a vertically transmitted HIV-infected 8-year-old girl with end-stage kidney disease on haemodialysis due to HIVAN. The pretransplant preparations and post-transplant care, with particular emphasis on immunosuppression and avoidance of opportunistic infections, are discussed.

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Immunosuppression Regimen and the Risk of Acute Rejection in HIV-Infected Kidney Transplant Recipients

Abstract: These findings support a role for ATG induction, and caution against the use of sirolimus-based maintenance therapy, in HIV-positive individuals undergoing KT.

Cited by 83 publications

References 26 publications

Alemtuzumab induction therapy in HIV-positive renal transplant recipients

Alemtuzumab induction therapy in HIV-positive renal transplant recipients

Validating Early Post–Transplant Outcomes Reported for Recipients of Deceased Donor Kidney Transplants

Successful outcome of renal transplantation in a child with HIV-associated nephropathy

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