title: High incidence of delayed graft function in HIV-infected kidney transplant recipients.
abstract: Kidney transplantation (KT) outcomes in human immunodeficiency virus (HIV)-infected recipients are under continuous research. High incidence of early post-transplant complications such as acute rejection has been observed. A multicenter study including HIV-infected patients who underwent KT in Spain, from 2001 to 2011, was performed. The study population included 108 recipients, 36 HIV-infected, and 72 matched HIV-negative KT recipients. HIV-infected recipients developed more delayed graft function (DGF) (52% vs. 21%, P < 0.001). One- and 3-year graft survival was 91.6% and 86.2% in HIV-infected patients, and 97.1% and 94.7% in HIV-negative patients (P = 0.052). In two-variate Cox analysis, HIV infection was not a predictor of graft loss after adjusting for time on dialysis, acute rejection, and DGF. Multivariate analysis for DGF revealed HIV-positive status as independent risk factor. We analyzed the evolution of immunosuppressive and antiretroviral therapy (ART). In HIV-infected patients tacrolimus trough levels were very high in the first week and significantly lower in the second week post-transplant (P = 0.042). Post-transplant ART was significantly changed: protease inhibitors use decreased (P = 0.034) and integrase inhibitor use increased (P < 0.001). DGF is another frequent early complication in HIV-infected recipients that can affect graft survival. Strategies to prevent DGF and antiretroviral regimes with less drug interactions could improve outcomes.
authors.affiliation: Renal Transplant Unit, Hospital Puerta del Mar, Cadiz, Spain. mauxiliadora.mazuecos.sspa@juntadeandalucia.es
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Mazuecos
authors.forename: Ana
authors.initials: A
authors.lastname: Fernandez
authors.forename: Sofia
authors.initials: S
authors.lastname: Zarraga
authors.forename: Amado
authors.initials: A
authors.lastname: Andres
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodriguez-Benot
authors.forename: Carlos
authors.initials: C
authors.lastname: Jimenez
authors.forename: Ernesto
authors.initials: E
authors.lastname: Gomez
authors.forename: Javier
authors.initials: J
authors.lastname: Paul
authors.forename: Luisa
authors.initials: L
authors.lastname: Jimeno
authors.forename: Constatino
authors.initials: C
authors.lastname: Fernandez
authors.forename: Dolores
authors.initials: D
authors.lastname: Burgos
authors.forename: Ana
authors.initials: A
authors.lastname: Sanchez-Fructuoso
authors.forename: Lluis
authors.initials: L
authors.lastname: Guirado
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D007166:Immunosuppressive Agents
keywords: acute rejection; delayed graft function; human immunodeficiency virus infection; kidney transplantation