title: Renal transplantation in HIV-infected patients: experience at a tertiary hospital in Spain and review of the literature.
abstract: BACKGROUND
  The use of highly active antiretroviral therapy (HAART) has decreased the morbidity and mortality in HIV-infected patients. The kidney transplantation (KT) survival rate is similar to that of HIV-negative transplant recipients. The consensus criteria for the selection of HIV patients for transplantation include: no opportunistic infections, CD4 lymphocyte count greater than 200 cells/μL, and an undetectable viral load. In Spain, HIV-infected patients present with different characteristics compared to American recipients; this could influence posttransplantation outcomes.
  
  
  OBJECTIVE
  This study analyzed the outcome and the clinical characteristics of HIV-infected patients who received KT in Spain in the HAART era.
  
  
  METHODS
  We retrospectively reviewed the clinical charts of seven adult HIV-infected recipients of primary renal allografts between January 2001 and June 2012. Patient inclusion criteria met the American and Spanish guidelines. The immunosuppressive protocol consisted of tacrolimus, mycophenolate mofetil, and steroids.
  
  
  RESULTS
  The median age was 44.8 years (interquartile amplitude = 9.4). The predominant mode of transmission was intravenous drug use (71.4%) and hepatitis C virus coinfection (71.4%). The most frequent cause of end-stage renal disease was glomerulonephritis (57.1%). Six patients (85.7%) were on HAART. All patients had controlled HIV infections with undetectable viral load and a median CD4 lymphocyte count of 504 cells/μL (IQA 599). Patients were followed for a median of 16.0 months (range, 3.0 to 96.6 months). Delayed graft function and acute rejection rates were 60% and 40%, respectively. The median creatinine level at the last follow-up was 1.58 mg/dL (IQA 1.15). In one case, a high-grade Epstein-Barr virus-related B cell lymphoma was diagnosed at 83 months after renal transplantation.
  
  
  CONCLUSIONS
  Kidney transplantation in HIV-infected patients is a safe, effective treatment for selected patients. Midterm graft survival was comparable to that of HIV-negative patients.
authors.affiliation: Urology Department, Ramón y Cajal University Hospital, Alcalá University, Madrid, Spain. Electronic address: vgomezd69@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Gómez
authors.forename: A
authors.initials: A
authors.lastname: Fernández
authors.forename: C
authors.initials: C
authors.lastname: Galeano
authors.forename: J
authors.initials: J
authors.lastname: Oliva
authors.forename: V
authors.initials: V
authors.lastname: Diez
authors.forename: C
authors.initials: C
authors.lastname: Bueno
authors.forename: V
authors.initials: V
authors.lastname: Hevia
authors.forename: F J
authors.initials: FJ
authors.lastname: Burgos
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D012189:Retrospective Studies; D013030:Spain; D062606:Tertiary Care Centers