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Introduction Transplantation among HIV positive patients may be a valuable therapeutic intervention. This study involves an HIV D+/R+ kidney–liver transplantation, where PBMC-associated HIV quasispecies were analyzed in donor and transplant recipients (TR) prior to transplantation and thereafter, together with standard viral monitoring. Methods The donor was a 54 year of age HIV infected woman: kidney and liver recipients were two HIV infected men, aged 49 and 61. HIV quasispecies in PBMC was analyzed by ultra-deep sequencing of V3 env region. During TR follow-up, plasma HIV-1 RNA, HIV-1 DNA in PBMC, analysis of proviral integration sites and drug-resistance genotyping were performed. Other virological and immunological monitoring included CMV and EBV DNA quantification in blood and CD4 T cell counts. Results Donor and TR were all ART-HIV suppressed at transplantation. Thereafter, TR maintained a nearly suppressed HIV-1 viremia, but HIV-1 RNA blips and the increase of proviral integration sites in PBMC attested some residual HIV replication. A transient peak in HIV-1 DNA occurred in the liver recipient. No major changes of drug-resistance genotype were detected after transplantation. CMV and EBV transient reactivations were observed only in the kidney recipient, but did not require specific treatment. CD4 counts remained stable. No intermixed quasispecies between donor and TR was observed at transplantation or thereafter. Despite signs of viral evolution in TR, HIV genetic heterogeneity did not increase over the course of the months of follow up. Conclusions No evidence of HIV superinfection was observed in the donor nor in the recipients. The immunosuppressive treatment administrated to TR did not result in clinical relevant viral reactivations.

Potential recipients pre-transplantation screening represents an essential step of kidney transplantation. Screening is mainly directed to identify conditions before transplantation and treating underlying diseases of potential recipients. Therefore, it's crucial to identify the patients at higher risk after transplantation and those who are not suitable for transplantation. A waiting period can modify the basal clinical picture necessitating a systematic clinical reassessment to confirm transplantation suitability. Our aim was to evaluate a nephrological management of waiting list recipients in a single Transplant Center in the first eight years of activity. We report our evaluation, the interaction with a network of specialists and the modification of our clinical behaviour considering the increase of high risk transplantation candidates, especially because of cardiovascular and infectious comorbidities and the consequent relationship with patients' Nephrology Units. Our experience shows that a periodical and systematic re-evaluation allows to extend patients' transplant program suitability with better outcomes after transplantation.

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The purpose of the present study was to determine the association between presence and progression of Coronary Artery Calcifications (CAC) quantified with Agatston Score (AS) and inflammatory index as CRP and other parameters in unselected renal transplant recipients. Forty-five patients were underwent a baseline Multislice CT (MSCT) at the time of renal transplant and a repeat evaluation 12 -16 months later. After second MSCT recipients were divided in three groups: Gr1 (26 patients) with absence of CAC at basal and second MSCT, Gr2 (11 patients) with reduction of CAC after one year and Gr3 (8 patients) with increased values of CAC after one year. Mean +/− Standard deviation of basal and after one year values of AS and CRP were respectively: Gr1: 2 +/− 3; 2 +/− 5 and 0.4 +/− 0.3; 0.55 +/− 0.67; Gr2: 317 +/− 288; 212 +/− 242 and 0.9 +/− 1.1; 0.55 +/− 0.6; Gr3: 854 +/− 1168; 1032 +/− 1153 and 0.8 +/− 0.8; 1.1 +/− 0.96. We found capacity of renal transplantation to protect against development of new calcium deposits in recipients without CAC at time of transplantation. While we confirmed association in Gr2 between reduction of CAC with reduction of CRP levels and in Gr3 between increased levels of CRP with increasing of CAC. Conclusion: In this preliminary study, renal transplantation appears to slow down or increasing CAC, in strict association with modifications of CRP levels. Long term studies are needed to confirm our preliminary data and to determine the effects of CAC on cardiovascular morbidity and mortality in renal transplant recipients.