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Kidney Transplant in HIV-Infected Patients
Survival after renal transplant is similar between HIV-infected and -uninfected individuals, although rates of graft loss may be higher among HIV-infected patients.
Kidney disease is an important cause of morbidity and mortality in HIV-infected patients. Only recently, however, did such patients become eligible to receive renal transplants for treatment of end-stage renal disease. Now, using data from a national registry, investigators have compared outcomes of primary renal transplant in 100 HIV-infected patients and 36,492 HIV-uninfected patients.
One-year survival rates did not differ significantly between HIV-infected and -uninfected patients (95% and 96%, respectively). However, the 1-year graft survival rate was significantly lower in the HIV-infected group (88% vs. 95%), even after adjustment for factors associated with graft loss. Several factors could have contributed to this lower rate, including donor age and delayed graft function. In fact, in subgroup analyses, HIV-infected patients who did not develop delayed graft function and those who received kidneys from young donors (age <50) had graft survival rates similar to those seen in uninfected patients. Increased rates of delayed graft function in HIV-infected patients might have been related to prolonged cold ischemic time (CIT) during surgery and use of kidneys from deceased donors.
Comment: This retrospective study adds to a growing body of evidence that HIV-infected patients have good outcomes after renal transplant. Using living donors and minimizing CIT during surgery might improve the results even further. An ongoing prospective, multicenter trial is expected to provide additional information about the safety and efficacy of renal transplant in HIV-infected patients. Although we have more to learn about improving outcomes, including how to optimally manage interactions between antiretroviral and immunosuppressant medications, we should no longer deny HIV-infected patients the opportunity to receive renal transplants.
Published in Journal Watch HIV/AIDS Clinical Care February 23, 2009
Citation(s):
Locke JE et al. Renal transplant in HIV-positive patients: Long-term outcomes and risk factors for graft loss. Arch Surg 2009 Jan; 144:83.
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