Kidney transplantation in HIV-positive adults: the UK experience

Abstract

HIV-positive patients are at increased risk of end-stage kidney disease (ESKD). Kidney transplantation (KT) is an established treatment modality for ESKD in the general population. Recent data have confirmed the feasibility of kidney transplantation in HIV-positive patients, and kidney transplantation is increasingly offered to ESKD patients with well-controlled HIV infection. We report clinical outcomes in a national cohort study of kidney transplantation in HIV-positive patients. In all, 35 HIV-positive KT recipients who had undergone KT up to December 2010 (66% male, 74% black ethnicity) were identified; the median CD4 cell count was 366, all had undetectable HIV RNA levels at kidney transplantation, and 44% received a kidney from a live donor. Patient survival at 1 and 3 years was 91.3%, and graft survival 91.3% and 84.7%, respectively. At one-year post-kidney transplantation, the cumulative incidence of acute rejection was 48%, and the median (IQR) eGFR was 64 (46, 78) mL/min/1.73 m(2). Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of kidney transplantation in HIV-positive patients. The high rates of acute rejection suggest that the optimal immune suppression strategy in this population remains to be refined.

End-Stage Kidney Disease and Kidney Transplantation in HIV-Positive Patients

“…4,5,9 Although PI-sparing cART regimens may thus be preferable in the setting of KT, less than half of our pre-KT/post-KT patients were managed with such regimens, most commonly as a result of documented HIV resistance. Tenofovir and atazanavir, drugs with nephrotoxic potential that may be best avoided in the setting of KT, were used in relatively few patients.…”

“…Typically, these patients had CD4 cell counts .200 cells per cubic millimeter, undetectable HIV RNA levels, and were free of opportunistic disease, malignancy, and severe vascular or hepatic comorbidities. 4,5 Although overall survival of KT patients has been favorable, it remains unclear whether KT affords a survival benefit over dialysis in those who are suitable for transplantation. The objectives of this study were to describe the use of and barriers to KT in HIV-positive patients with ESKD and to compare the survival of patients with ESKD managed with KT and dialysis.…”

Marginal Donors in Renal Transplantation

“…HIV-positive status in living donor is currently the only indication for mandated exclusion under the National Organ Transplant Act [66]; however, HIV-positive ESRD patients can receive graft donations from living donors [67]. It is worth mentioning that although HIV viremia and HIV disease progression are not common, the risks of renal complications and acute rejection in recipient HIV-positive patients are quite high.…”

Update on kidney transplantation in human immunodeficiency virus infected recipients

“…Three year patient and allograft survival rates were 91.3% and 87.4% respectively. Acute rejection rate was 44% and 2 patients developed BK nephropathy [22] .…”