title: Kidney transplantation in HIV-positive adults: the UK experience.
abstract: HIV-positive patients are at increased risk of end-stage kidney disease (ESKD). Kidney transplantation (KT) is an established treatment modality for ESKD in the general population. Recent data have confirmed the feasibility of kidney transplantation in HIV-positive patients, and kidney transplantation is increasingly offered to ESKD patients with well-controlled HIV infection. We report clinical outcomes in a national cohort study of kidney transplantation in HIV-positive patients. In all, 35 HIV-positive KT recipients who had undergone KT up to December 2010 (66% male, 74% black ethnicity) were identified; the median CD4 cell count was 366, all had undetectable HIV RNA levels at kidney transplantation, and 44% received a kidney from a live donor. Patient survival at 1 and 3 years was 91.3%, and graft survival 91.3% and 84.7%, respectively. At one-year post-kidney transplantation, the cumulative incidence of acute rejection was 48%, and the median (IQR) eGFR was 64 (46, 78) mL/min/1.73 m(2). Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of kidney transplantation in HIV-positive patients. The high rates of acute rejection suggest that the optimal immune suppression strategy in this population remains to be refined.
authors: King's College London, London, UK.
authors: Esther N
authors: EN
authors: Gathogo
authors: Lisa
authors: L
authors: Hamzah
authors: Rachel
authors: R
authors: Hilton
authors: Neal
authors: N
authors: Marshall
authors: Caroline
authors: C
authors: Ashley
authors: Mark
authors: M
authors: Harber
authors: Jeremy B
authors: JB
authors: Levy
authors: Rachael
authors: R
authors: Jones
authors: Marta
authors: M
authors: Boffito
authors: Saye H
authors: SH
authors: Khoo
authors: Martin
authors: M
authors: Drage
authors: Sanjay
authors: S
authors: Bhagani
authors: Frank A
authors: FA
authors: Post
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: AIDS; HIV; HIV-associated nephropathy; HIVAN; antiretroviral therapy; calcineurin inhibitor; dialysis; end stage kidney disease; kidney; renal failure; transplantation