Infectious complications in HIV-infected kidney transplant recipients

Abstract

Renal transplantation is now a viable alternative for dialysis in HIV-infected patients who achieve good immunovirological control with current antiretroviral therapy regimens available. However, there are few studies that analyze the incidence of post-transplant infections in this population. In this study, a retrospective analysis of data files of 24 HIV-infected kidney transplant (KT) recipients was undertaken, matched to 21 non-infected controls. All patients received induction with anti-interleukin-2 antibodies and were followed in the Pitié-Salpêtrière Hospital in Paris, France. The rate of incidence of post-transplant infections was 23.58 and 26.98/100 patient-years, in HIV-infected and HIV-negative groups (relative risk [RR]: 0.90; 95% confidence interval [CI]: 0.58-1.39; p = 0.63). In HIV-infected KT recipients, bacterial infections were the most frequent (67.7%), followed by viral (14.7%) and fungal and parasitic infections (8.8%). Similar trends were seen in the control group. Incidence of opportunistic infections was similar in HIV-infected KT recipients and controls (38.2 vs. 26.5%; p = 0.44). There were three post-transplant HIV reactivations in two patients, secondary to poor adherence to medication. HIV status did not influence survival, but infections increased the risk of unfavorable outcome. Incidence of post-transplant infections was similar in HIV-infected KT recipients and controls. Infections, but not HIV status, had adverse effects on patient and graft survival.

Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis

“…During the first decades of the renal transplantation era, a serious IC developed in up to 70% of patients following transplantation, resulting in fatal outcomes in as many as 11% to 40% of cases [37]. In a recent case–control study with a median follow-up of 5 years, Ailioaie et al [38] found a similar incidence of post-transplant IC in HIV+ KT recipients compared with matched KT HIV− controls. An IC incidence of 29% after transplantation was previously reported [19], and the incidence of post-transplant neoplasms has been described as similar to the incidence in HIV− patients.…”

Access to the waiting list and to kidney transplantation for people living with HIV: A national registry study

“…[7][8][9][10][11][12][13][14][15][16][17][18][19] At the time of this finding, this poor renal outcome was possibly, in part, due to a higher rate of acute rejection of PLHIV because of insufficient induction therapy. 8,20 However, although KT should be the standard of care for eligible PLHIV, 18,21 nephrologists might still be reluctant to offer this therapeutic option, for fear of a higher risk of general or surgical site infection 9,22,23 due to profound immunosuppression. 8,20 However, although KT should be the standard of care for eligible PLHIV, 18,21 nephrologists might still be reluctant to offer this therapeutic option, for fear of a higher risk of general or surgical site infection 9,22,23 due to profound immunosuppression.…”

“…7,8 Indeed, the importance of T cell depleting induction in PLHIV has only recently been established. 8,20 However, although KT should be the standard of care for eligible PLHIV, 18,21 nephrologists might still be reluctant to offer this therapeutic option, for fear of a higher risk of general or surgical site infection 9,22,23 due to profound immunosuppression. The possible interactions between antiretroviral and immunosuppressive drugs requiring complex drug monitoring 24,25 might also be a disincentive.…”

Conversion to belatacept maintenance immunosuppression in HIV‐positive kidney transplant recipients

“…Belatacept did not appear to worsen HIV infection–related outcomes in our small patient cohort and was associated with an incidence of infectious complications similar to that described in previous publications. In a case‐control study with a median of 5 years of follow‐up, Ailioaie et al 5 reported an incidence of opportunistic infections of 38.2% for HIV + kidney transplant patients compared to 26.5% for HIV‐ controls ( P = .44). We observed a similar incidence after a median 3.3 years of follow‐up, with 3/10 (30%) of patients admitted for infectious complications, all of whom responded to appropriate antibiotic therapy.…”

“…While HIV infection was previously considered a contraindication to transplantation due to concern for opportunistic infections and early reports of poor patient and allograft survival, today HIV + transplant recipients demonstrate allograft survival rates similar to their HIV‐ counterparts and improved survival relative to patients remaining on dialysis 2,3 . Despite improvements in HIV + transplant outcomes, rates of acute rejection and infectious complications remain higher than those observed in the general transplant population, and selection of the optimal immunosuppression strategy remains challenging 3‐5 . Since publication of the landmark trial by Stock et al, standard maintenance immunosuppression for HIV + transplant recipients has generally consisted of tacrolimus, mycophenolate mofetil (MMF), and tapering corticosteroids 3,6,7 .…”