Kidney Transplantation in HIV-Infected Recipients: Therapeutic Strategy and Outcomes in Monocentric Experience.
BACKGROUND
In Human immunodeficiency virus (HIV)-positive patients undergoing kidney transplantation, outcomes and immunosuppression (IS) protocol are not yet established due to infectious and neoplastic risks as well as to pharmacokinetic interactions with antiretroviral therapy (TARV).


METHODS
We report a retrospective, 1-center study on 18 HIV+ patients undergoing, between October 2007 and September 2015, kidney transplantation (13 cases) or combined kidney-liver transplant (5 cases). Inclusion criteria for transplant were based on the Italian National Transplant Center protocol. IS regimen was based on quick tapering of steroids and the use of mTOR inhibitors (mTORi) with low dose of calcineurin inhibitors (CNI). In the early post-transplant period, TARV was based on enfuvirtide, raltegravir, plus 1 or more nucleoside analogues.


RESULTS
In a mean follow-up of 3.1 years, patient survival rate at 1 and 3 years was, respectively, 86.6% and 84.6%, whereas graft survival was 81.2% and 78.6%. Cumulative rejection rate was 20.0% and 26.6% (1- and 3-year results). Median eGFR (MDRD) was 58.8 mL/min and 51.9 mL/min at 1 and 3 years. We had 9 cases of clinically relevant infections (2 Pneumocystis jirovecii pneumonia, 1 pulmonary aspergillosis, 2 severe sepsis, and 4 HCV reactivation) as well as 1 case (5.5%) of HIV reactivation.


CONCLUSIONS
IS therapy based on mTORi and low CNI dose ensures good graft survival, low rate of acute rejection, limited drug toxicity, and control of HIV disease. TARV has no significant interaction with IS therapy.
University of Modena and Reggio Emilia, University Hospital Policlinico of Modena, Modena, Italy. Electronic address: albertobaisi86@gmail.com.
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Baisi
University of Modena and Reggio Emilia, University Hospital Policlinico of Modena, Modena, Italy.
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Nava
University of Modena and Reggio Emilia, Division of Urology, University Hospital Policlinico of Modena, Modena, Italy.
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Baisi
University of Modena and Reggio Emilia, University Hospital Policlinico of Modena, Modena, Italy.
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Rubbiani
University of Modena and Reggio Emilia, Division of Infectious Diseases, University Hospital Policlinico of Modena, Modena, Italy.
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Guaraldi
University of Modena and Reggio Emilia, Division of Liver-Bilio-Pancreatic Surgery and Liver Transplantation, University Hospital Policlinico of Modena, Modena, Italy.
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Di Benedetto
University of Modena and Reggio Emilia, Division of Angiology and Vascular Surgery, University Hospital Policlinico of Modena, Modena, Italy.
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Giovannoni
University of Modena and Reggio Emilia, University Hospital Policlinico of Modena, Modena, Italy.
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Solazzo
Nephrology of Area Nord, Carpi, Italy.
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Bonucchi
University of Modena and Reggio Emilia, University Hospital Policlinico of Modena, Modena, Italy.
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Cappelli
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery* / Q000821:virology; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
D000998:Antiviral Agents; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D058570:TOR Serine-Threonine Kinases