title: Renal transplantation in human immunodeficiency virus-positive patients: a report of four cases.
abstract: BACKGROUND
  Renal transplantation (RT) in patients infected with human immunodeficiency virus (HIV) has significantly improved under the advent of combined antiretroviral therapy (cART). The authors describe their experience in RT in patients with HIV from September 2010 to June 2013.
  
  
  METHODS
  Four patients underwent transplantation (3 with HIV-1 and 1 with HIV-2), three patients were male, and one was black. None were coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV). Etiology of kidney disease was HIV-associated nephropathy (2 patients), immunoglobulin (Ig)A nephropathy, and unknown. Average age at RT was 51 (range, 41-63) years. No patient was of high immunologic risk. Immunosuppression consisted of basiliximab for induction and prednisolone, tacrolimus (TAC), and mycophenolate mofetil for maintenance. TAC levels varied considerably in the early days (8.5-46 ng/mL), requiring major adjustments in TAC dose. Only the HIV-2 patient had delayed graft function. The follow-up of patients with HIV-1 was 37, 19, and 16 months, and 3 months for the HIV-2 patient. CD4+ T cells decreased in the early days after transplantation with subsequent improvement, along with persistent virological suppression. In the HIV-1 group there were no major infectious, cardiovascular, or neoplastic complications. Nevertheless, the HIV-2 patient died 3 months after RT due to H1N1 pneumonia complicated by pulmonary aspergillosis. Average estimated (CKD- EPI) glomerular filtration rate (eGFR) at 6 months was 85.6 mL/min/1.73 m(2).
  
  
  CONCLUSIONS
  Besides the difficulty in adjusting calcineurin inhibitors levels due to its interaction with antiretroviral therapy, namely with protease inhibitors, no patient had acute rejection. Furthermore, all patients presented an excellent control of viro-immunologic parameters. At the last follow-up neither cardiovascular events nor neoplastic complications were observed. Our results highlight the favorable outcome of RT in HIV-1-infected patients. The HIV-2 patient died due to severe infection, and the clinical management and potential benefit of RT in HIV-2-infected patients needs further study.
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal. Electronic address: anapmnunes@gmail.com.
authors.forename: A T
authors.initials: AT
authors.lastname: Nunes
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Pereira
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Cerqueira
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Bustorff
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Sampaio
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal.
authors.forename: I
authors.initials: I
authors.lastname: Ferreira
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal.
authors.forename: I
authors.initials: I
authors.lastname: Tavares
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Santos
authors.affiliation: Nephrology Department, Hospital São João, Oporto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Pestana
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D051799:Delayed Graft Function; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053118:Influenza A Virus, H1N1 Subtype; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000821:virology
chemical_list: D044966:Anti-Retroviral Agents; D007166:Immunosuppressive Agents