title: Simultaneous pancreas-kidney transplantation in HIV-infected patients: a case report and literature review.
abstract: Since the introduction of combined antiretroviral therapy (cART), solid organ transplantation (SOT) has become a therapeutic option for the HIV-positive population. In contrast with liver and kidney transplantation, only three simultaneous pancreas-kidney transplants (SPKT) have been reported among HIV-infected patients. Herein we have reported the first SPKT in an HIV-infected patient in Spain. The pancreas graft failed at 2 weeks and the patient died at 9 months because of a Pseudomonas aeruginosa infection. The three recipients reported in the literature lived, despite the failure of both the pancreas and kidney grafts in one subject. Despite the poor outcome of our case, HIV-1 infection was controlled after transplantation (stable CD4(+) cells and no AIDS-related events), and the kidney graft functioned with no episodes of rejection. The cART regimen used in the pretransplant period was switched at the time of transplantation to raltegravir and two nucleoside reverse transcriptase inhibitors (NRTI). Raltegravir has no interactions with immunosuppressive drugs. Target plasma levels of tacrolimus were achieved at a dose similar to that used in HIV-negative transplant recipients. The most adequate antiretroviral regimen for HIV-infected SOT recipients has not yet been established; however, one may consider switching protease inhibitors or non-NRTI-based regimens for a raltegravir-based regimen at the time of transplantation.
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain. jmmiro@ub.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Miro
authors.forename: M J
authors.initials: MJ
authors.lastname: Ricart
authors.forename: J C
authors.initials: JC
authors.lastname: Trullas
authors.forename: F
authors.initials: F
authors.lastname: Cofan
authors.forename: C
authors.initials: C
authors.lastname: Cervera
authors.forename: M
authors.initials: M
authors.lastname: Brunet
authors.forename: M
authors.initials: M
authors.lastname: Tuset
authors.forename: C
authors.initials: C
authors.lastname: Manzardo
authors.forename: F
authors.initials: F
authors.lastname: Oppenheimer
authors.forename: A
authors.initials: A
authors.lastname: Moreno
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D017809:Fatal Outcome; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects; D011552:Pseudomonas Infections / Q000209:etiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000472:pathogenicity; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D007166:Immunosuppressive Agents