title: Kidney transplantation in HIV-positive patients treated with a steroid-free immunosuppressive regimen.
abstract: One of the main concerns associated with renal transplantation in HIV-infected patients is the high risk of acute rejection, which makes physicians reluctant to use steroid-free immunosuppressive therapy in this subset of patients. However, steroid therapy increases cardiovascular morbidity and mortality. The aim of this study was to define the efficacy of a steroid-sparing regimen in HIV-infected renal transplant recipients. Thirteen HIV-infected patients were consecutively transplanted. The induction therapy consisted of basiliximab and methylprednisolone for 5 days followed by a calcineurin inhibitor plus mycophenolate acid. The mean follow-up was 50 ± 22 months. Eight patients (61.5%) experienced acute rejection, and 75% of the first episodes occurred within 2 months after transplantation. The probability of first acute rejection was 58% after 1 year and 69% after 4 years. Seven of eight patients recovered or maintained their kidney function after antirejection therapy and steroid resumption. At the last follow-up, seven of 13 patients (54%) had resumed steroid therapy. The 4-year patient and graft survivals were 100% and 88.9%, respectively. The benefits of this steroid-free regimen in HIV-infected renal recipients must be reconsidered because of the high rate of acute rejection. New immunosuppressive steroid-free strategies should be identi-fied in this set of patients.
authors: Operative Unit of Nephrology, A.O. Spedali Civili and University of Brescia, Brescia, Italy.
authors: Nicola
authors: N
authors: Bossini
authors: Silvio
authors: S
authors: Sandrini
authors: Salvatore
authors: S
authors: Casari
authors: Regina
authors: R
authors: Tardanico
authors: Roberto
authors: R
authors: Maffeis
authors: Gisella
authors: G
authors: Setti
authors: Francesca
authors: F
authors: Valerio
authors: Maria A
authors: MA
authors: Forleo
authors: Franco
authors: F
authors: Nodari
authors: Giovanni
authors: G
authors: Cancarini
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage*; D012189:Retrospective Studies; D018570:Risk Assessment; D013256:Steroids; D016019:Survival Analysis; D014181:Transplantation Immunology / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid
keywords: HAART; HIV; induction therapy; kidney transplantation; rejection; steroid-free regimen