First case of pancreas transplant alone in a patient with diabetes and HIV infection.
Chronic conditions have largely replaced opportunistic infections as the leading causes of mortality in human immunodeficiency virus (HIV) infection. Pancreas transplantation alone can be performed for people with difficult to manage diabetes associated with severe hypoglycaemic unawareness. For carefully selected patients, pancreas transplantation alone has the potential to dramatically improve quality and quantity of life. Historically, HIV was considered a contraindication to transplantation; however, today renal transplantation for people with end-stage kidney disease and HIV infection is increasingly common. We describe the use of a standard immunosuppression regimen in combination with effective antiretroviral control using a stable highly active antiretroviral therapy regimen with minimal interaction with immunosuppressants. We describe what is, to our knowledge, the first case of pancreas transplantation alone performed for this particularly challenging group, resulting in complete resolution of hypoglycaemic symptoms. We suggest that this group of patients should receive optimal diabetes management, including access to transplantation where appropriate, and demonstrate that pancreas transplantation alone is feasible for people with HIV infection.
Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK shruti.mittal@gstt.nhs.uk.
Shruti
S
Mittal
Department of Diabetic Medicine, Kings College Hospital, London, UK.
Pratik
P
Choudhary
Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK.
Chris
C
Callaghan
Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK.
Rachel
R
Hilton
Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK.
Martin
M
Drage
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D016035:Pancreas Transplantation; D016896:Treatment Outcome; D019562:Viral Load
D007166:Immunosuppressive Agents
AIDS; HIV; Pancreas; antiretroviral therapy; transplant; treatment