title: Alloantigen-specific response is preserved and autoimmunity is maintained in an HIV-positive patient with immunoglobulin A nephropathy undergoing renal transplantation: a warning about long-term reduction in immunosuppression--a case report.
abstract: We report the case of a 43-year-old patient with HIV infection treated with antiretroviral therapy, which was complicated by immunoglobulin A (IgA) nephropathy and renal failure, who subsequently was transplanted using a deceased donor kidney transplant. During the late posttransplant period we detected specific anti-donor HLA antibodies showing a preserved alloantigen response. A renal biopsy showed no acute cellular or humoral rejection, an absence of pericapillary C4d deposits or SV40 infected cells, but demonstrated IgA mesangial deposits and mild interstitial fibrosis probably related to calcineurin inhibitor toxicity. This case shows that allo- and autoimmune responses are preserved despite immunosuppressive treatment and original HIV disease. It warns of the importance of maintaining optimal monitoring and immunosuppressive strategies among HIV-positive recipients who become solid organ transplant recipients.
authors.affiliation: Clínica Las Condes, Santiago, Chile. jmorales@clc.cl
authors.forename: J
authors.initials: J
authors.lastname: Morales
authors.forename: A
authors.initials: A
authors.lastname: Alba
authors.forename: R
authors.initials: R
authors.lastname: Espinoza
authors.forename: C
authors.initials: C
authors.lastname: Sepúlveda
authors.forename: L
authors.initials: L
authors.lastname: Contreras
authors.forename: E
authors.initials: E
authors.lastname: Buckel
authors.forename: L
authors.initials: L
authors.lastname: Noriega
authors.forename: J A
authors.initials: JA
authors.lastname: Fierro
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000276:immunology / Q000601:surgery* / Q000821:virology; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015551:Autoimmunity / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005922:Glomerulonephritis, IGA / Q000276:immunology / Q000601:surgery* / Q000821:virology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007518:Isoantibodies / Q000097:blood; D007519:Isoantigens / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D012008:Recurrence; D051437:Renal Insufficiency / Q000276:immunology / Q000601:surgery* / Q000821:virology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D007519:Isoantigens