Malignancy in the HIV-infected patients undergoing liver and kidney transplantation

Abstract

Purpose of review The transplant community has seen gradual acceptance of liver and kidney transplantation (LT, KT) in carefully selected HIV positive patients. The addition of transplant immunosuppressants to an already immunocompromised state, however, may increase the risk of malignancy. Recent findings KT and LT have been successful in large series of carefully selected HIV infected patients, with graft and patient survival approaching those of non-HIV infected patients. The incidence of acute cellular rejection (KT) and of recurrent hepatitis C (LT) remains challenging. Hepatocellular carcinoma, which is a common indication for LT, seems to occur at a younger age and to have a generally worse outcome in the HIV+ patient. LT outcomes for HCC in these patients, however, do not seem to be compromised. Rates of Kaposi’s sarcoma (KS) and other de novo malignancies such as skin cancer are relatively low after transplant. KS may regress with use of the mTOR inhibitor sirolimus. In HIV+ patients followed closely for HPV-related anal neoplasia after transplantation there may be an increased risk of progression to high grade squamous intraepithelial lesions. Summary The risk of recurrent or de novo malignancy after solid organ transplantation in HIV patients is low. HPV-related neoplasia, however, requires further study.

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

“…Transplantation in HIV-infected adults is associated with an increased toxicity of immunosuppressive therapy,5 a higher rate of renal allograft rejection3 4 7 and risk of long-term HIV-associated complications 9. In this study, 150 carefully selected HIV-infected adults who underwent renal transplantation were prospectively followed up for a median period of 1.3 years.…”

“…Patients with HIVAN may have a higher risk of malignancies in their native kidneys after transplantation,3 9 and nephrectomies prior to transplantation have been considered by some experts. We continue to monitor our patient with 6-monthly renal ultrasound scans.…”

Perspectives on Liver and Kidney Transplantation in the Human Immunodeficiency Virus-Infected Patient

“…Emerging issues in the HIV-infected transplant field include determining the best drug combinations of antiretrovirals and immunosuppressive medications to administer, optimally treating Hepatitis C recurrence following transplantation, and following long term outcomes in patients. As these cohorts mature, they will also give us valuable information about malignancies (particularly those that are virally mediated like HPV-associated neoplasia) in this growing population (37). Nevertheless, demand for organs continue to outstrip supply.…”

Dimethyl Fumarate Modulation of Immune and Antioxidant Responses: Application to HIV Therapy

“…476 Furthermore, the increased risk of de novo or recurrent malignancy in HIV-infected patients undergoing solid-organ transplantation and subsequent immunosuppressive therapy was low. 477 …”