Renal Transplantation in Human Immunodeficiency Virus-Positive Patients: A Report of Four Cases

• Type: Article in International Scientific Journal
• Date: 2014

Authors

Nunes, AT (Author) Other; Pereira, L (Author) Other; Cerqueira, A (Author) Other; Bustorff, M (Author) Other; Sampaio, S (Author) FMUP; Ferreira, I (Author) Other; Tavares, I (Author) FMUP; Santos, J (Author) Other; Pestana M (Author) FMUP

Journal

Title: Transplantation Proceedings

Vol. 46

Pages: 1718-1722

ISSN: 0041-1345

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 1 Citation

Scopus - 0 Citations

Other information

Authenticus ID: P-009-RZY

DOI: 10.1016/j.transproceed.2014.05.030

Abstract (EN): Introduction. 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. Cases Report. 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). Conclusion. 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 HIV1-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.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 5