Influence of immune activation on the risk of allograft rejection in human immunodeficiency virus-infected kidney transplant recipients

Lorio, Marco A.; Rosa, Rossana; Suárez, José Francisco; Ruiz, Phillip; Ciancio, Gaetano; Burke, George W.; Camargo, José F.

doi:10.1016/j.trim.2016.06.001

Cited by 14 publications

(21 citation statements)

References 24 publications

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“…Consistent with previous studies of kidney transplantation in HIV 1 – 5 , we observed excellent transplant outcomes without evidence of HIV disease progression. The most important finding of the present study is the association between PI use and adverse outcomes, namely reduced three-year patient and graft survival, and increased risk of serious non-opportunistic infections.…”

Section: Discussionsupporting

confidence: 91%

“…CNI levels at 4, 12, 26 and 52 weeks were comparable across ART groups. Other factors, such as infection of the allograft, previous alloimmunization and immune activation, might also play a role in predisposition to rejection 3 , 5 , 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Immunosuppression and antimicrobial prophylaxis protocols at our center have been previously described 4 , 5 .…”

Section: Methodsmentioning

confidence: 99%

“…More than 500 kidney transplants in human immunodeficiency virus–infected (HIV + ) recipients have been performed in the United States with acceptable outcomes 1 – 5 . HIV infection is associated with a two- to three-fold increase in the risk of rejection 3 .…”

Section: Introductionmentioning

confidence: 99%

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Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients: Review of 58 cases

et al. 2016

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Background: Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients. We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV + kidney transplant recipients. Methods: A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV - to HIV + adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation. The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant. Results: Patient and graft survival at three years were both 90% for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85% vs. 100% ( p=0.06) and 82% vs. 100% ( p=0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95% confidence interval, 1.31-1602; p=0.02). Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100%, p=0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8%, p=0.01). Conclusions: PI-containing ART regimens are associated with adverse outcomes in HIV + kidney transplant recipients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

“…Immunosuppression and antimicrobial prophylaxis protocols at our center have been previously described 4 , 5 .…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients: Review of 58 cases

et al. 2016

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“…Maintenance IS included tacrolimus, mycophenolate mofetil, and prednisone. Additional details about IS and antimicrobial prophylaxis protocols at our center have been previously described …”

Section: Methodsmentioning

confidence: 99%

Clinical outcomes in HIV+/HCV+ coinfected kidney transplant recipients in the pre‐ and post‐direct‐acting antiviral therapy eras: 10‐Year single center experience

Camargo

Anjan

Chin‐Beckford

et al. 2019

Clinical Transplantation

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Background: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV− recipients. However, these studies were conducted prior to the availability of direct-acting antiviral (DAA) agents and data in the modern era are lacking. Methods: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (ie, after December 2013) eras including 1-year patient survival, death-censored graft survival, and acute rejection; and serious infections (defined as infections requiring admission to the intensive care unit during initial transplant hospitalization or re-admission to the hospital after discharge) within the first 6 months post-transplant. Results: A total of 13 consecutive HIV+/HCV+ recipients were identified. Median time of post-transplant follow-up was 722 days. Seven patients were transplanted in the DAA era; five of them had anti-HCV Ab+ donors, with two donors being HCV NAT positive; all received DAA therapy, six of them post-transplant (median time from KT to DAA: 83 days; IQR, 54-300). All the patients in the pre-DAA era were on a protease inhibitor-containing ART regimen. One-year patient and death-censored graft survivals were 83% and 67%, respectively, for the patients transplanted in the pre-DAA era, and 100% for both outcomes in the subgroup of patients transplanted in the post-DAA era (P > 0.05). Compared to patients in the post-DAA era, those in the pre-DAA era had higher incidence of serious infections (0 vs 67%; P = 0.02).Acute rejection exclusively occurred in the pre-DAA group (n = 1; 17%). Conclusions:Outcomes of HIV+/HCV+ KT recipients, including HIV−/HCV+ to HIV+/ HCV+ transplants, in the DAA era were excellent in this small cohort. Larger studies are needed.

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Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers

Werbel

Durand

2019

Curr HIV/AIDS Rep

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a) Purpose of review: What Is the goal of your paper? What questions did you seek to answer-End-stage organ disease prevalence is increasing among HIV-infected (HIV+) individuals. Trial and registry data confirm that solid organ transplantation (SOT) is efficacious in this population. Optimizing access to transplant and decreasing complications represent active frontiers. b) Recent findings: Summarize the latest research on your topic.-HIV+ recipients historically experienced 2-4 fold higher rejection. Integrase strand transferase inhibitors (INSTIs) minimize drug-interactions and may reduce rejection along with lymphodepleting induction immunosuppression. Hepatitis C virus (HCV) coinfection has been associated with inferior outcomes, yet direct-acting antivirals (DAAs) may mitigate this. Experience in South Africa and the US HIV Organ Policy Equity (HOPE) Act support HIV+ donor to HIV+ recipient (HIV D+/R +) transplantation. c) Summary: What answers did you find? What are the major takeaways/ conclusions of your examination? What's the impact on future research?-SOT is the optimal treatment for end-stage organ disease in HIV+ individuals. Recent advances include use of INSTIs and DAAs in transplant recipients, however strategies to improve access to transplant are needed. HIV D+/R+ transplantation is under investigation and may improve access and provide insights for HIV cure and pathogenesis research.

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Influence of immune activation on the risk of allograft rejection in human immunodeficiency virus-infected kidney transplant recipients

Cited by 14 publications

References 24 publications

Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients: Review of 58 cases

Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients: Review of 58 cases

Clinical outcomes in HIV+/HCV+ coinfected kidney transplant recipients in the pre‐ and post‐direct‐acting antiviral therapy eras: 10‐Year single center experience

Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers

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