Preliminary experience with renal transplantation in HIV+ recipients: low acute rejection and infection rates.
BACKGROUND
Only four centers have reported their results with renal transplantation in human immunodeficiency virus (HIV)+ recipients on highly active antiretroviral therapy, and acute rejection (AR) rates have consistently ranged from 43% to 67%.


METHODS
We examined the outcomes of eight adult HIV+ primary renal allograft recipients with median 15 (range 8-47) months follow-up with multiple other high-risk factors, including African American ethnicity, hepatitis C virus (HCV) positivity, long waiting times, prior sensitization, paucity of live donors, and delayed graft function. Our immunosuppressive protocol consisted of an anti-interleukin-2 receptor antibody for induction, and mycophenolate mofetil, cyclosporin A, and prednisone for maintenance. Initial and 3- to 6-month cyclosporin A trough level targets were 250 to 300 and 225 to 275 ng/mL, respectively, and mycophenolate mofetil dose was adjusted according to 2 to 4 week surveillance and subsequent as needed mycophenolic acid predose concentrations during the first 6 months.


RESULTS
Patient and graft survival were 100% and 88%, respectively, with an AR rate of 13% and excellent renal function. No patients developed new-onset diabetes, opportunistic or other serious infections, malignancy, or progression of hepatitis C virus-related liver disease. Excellent suppression of HIV replication with maintenance of CD4 counts was noted in all cases.


CONCLUSIONS
Our findings suggest that HIV+ patients on highly active antiretroviral therapy can undergo successful renal transplantation with a low incidence of both AR and AIDS-associated and non-AIDS associated infections, despite associated risk factors for poorer outcome. Our encouraging but preliminary results with this protocol will need to be verified in larger numbers of HIV+ renal allograft recipients with longer follow-up.
Gruber
Scott A
SA
Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI 48201, USA. sgruber@dmc.org
Doshi
Mona D
MD
Cincotta
Elizabeth
E
Brown
Kristian L
KL
Singh
Atul
A
Morawski
Katherina
K
Alangaden
George
G
Chandrasekar
Pranatharthi
P
Losanoff
Julian E
JE
West
Miguel S
MS
El-Amm
Jose M
JM
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015375:Receptors, Interleukin-2 / Q000737:chemistry; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
D015375:Receptors, Interleukin-2