title: Preliminary experience with renal transplantation in HIV+ recipients: low acute rejection and infection rates.
abstract: 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.
authors.affiliation: Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI 48201, USA. sgruber@dmc.org
authors.forename: Scott A
authors.initials: SA
authors.lastname: Gruber
authors.forename: Mona D
authors.initials: MD
authors.lastname: Doshi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cincotta
authors.forename: Kristian L
authors.initials: KL
authors.lastname: Brown
authors.forename: Atul
authors.initials: A
authors.lastname: Singh
authors.forename: Katherina
authors.initials: K
authors.lastname: Morawski
authors.forename: George
authors.initials: G
authors.lastname: Alangaden
authors.forename: Pranatharthi
authors.initials: P
authors.lastname: Chandrasekar
authors.forename: Julian E
authors.initials: JE
authors.lastname: Losanoff
authors.forename: Miguel S
authors.initials: MS
authors.lastname: West
authors.forename: Jose M
authors.initials: JM
authors.lastname: El-Amm
mesh_terms: 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
chemical_list: D015375:Receptors, Interleukin-2