Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis

Abstract

BackgroundKidney transplantation is now a viable alternative to dialysis in HIV-positive patients who achieve good immunovirological control with the currently available antiretroviral therapy regimens. This systematic review and meta-analysis investigate the published evidence of outcome and risk of kidney transplantation in HIV-positive patients following the PRISMA guidelines.MethodsSearches of PubMed, the Cochrane Library and EMBASE identified 27 cohort studies and 1670 case series evaluating the survival of HIV-positive kidney transplant patients published between July 2003 and May 2018. The regimens for induction, maintenance therapy and highly active antiretroviral therapy, acute rejection, patient and graft survival, CD4 count and infectious complications were recorded. We evaluated the patient survival and graft survival at 1 and 3 years respectively, acute rejection rate and also other infectious complications by using a random-effects analysis.ResultsAt 1 year, patient survival was 0.97 (95% CI 0.95; 0.98), graft survival was 0.91 (95% CI 0.88; 0.94), acute rejection was 0.33 (95% CI 0.28; 0.38), and infectious complications was 0.41 (95% CI 0.34; 0.50), and at 3 years, patient survival was 0.94 (95% CI 0.90; 0.97) and graft survival was 0.81 (95% CI 0.74; 0.87).ConclusionsWith careful selection and evaluation, kidney transplantation can be performed with good outcomes in HIV-positive patients.

Contemporary issues and new challenges in chronic kidney disease amongst people living with HIV

“…It is preferable to modify ART to avoid these drug-drug interactions, before kidney transplantation is undertaken [149]. An increase in the risk of acute rejection demonstrated in this group has meant that Tacrolimus-based immunosuppression is used preferentially, with some transplant centres also using additional induction therapy [150]. Despite the increased risk of acute kidney transplant rejection amongst PLWHIV, outcomes are similar to the non-infected population [151].…”

Tacrolimus, Sirolimus and Everolimus Doses in HIV-Infected Solid-Organ Recipients, Requiring a Cobicistat-Based Antiretroviral Regimen: Report of Three Cases and Review

“…Outcomes of liver and kidney transplant in PLWH have been consistent with those in HIVuninfected people, especially in the absence of HCV co-infection [24]. Although higher rates of acute graft rejection in PLWH undergoing SOT are still a matter of concern (in part consequent to difficulties in adapting immunosuppressors concomitantly with certain ARTs), several studies have reported patient and graft survival rates in long-term follow-up of HIV-positive kidney-transplant recipients similar to those who were HIV negative [25][26][27]. Regarding liver transplantation in HIV/HCV co-infected patients, since DAAs became available, SVRs prior to and post liver transplantation are comparable to those of HCV-mono-infected patients [28,29].…”

The first report of kidney transplantation in a human immunodeficiency virus–positive recipient in Thailand and literature review: Encouragement for developing countries in Southeast Asia

“… 9 Evidences have shown that the allograft and patient survival rates are comparable between the HIV-monoinfected and the HIV-negative kidney transplant recipients. 10 – 12 However, some studies demonstrated that the HIV-positive recipients had inferior long-term patient survival compared with the HIV-negative. 5 , 13 The difference in survival among these studies could be explained from the changing era of immunosuppression, the different ART used, and the HCV co-infection.…”

“…Kidney transplantation recipients with HIV infection are at higher risk of acute rejection than HIV-negative recipients (the risks are approximately 30% and 10% in the first year after transplantation, respectively). 5 , 6 , 11 There are many hypotheses regarding the high rejection rate, including HIV containing HLA molecules, the memory phenotype of T lymphocytes in HIV-positive patients, HIV-associated immune dysregulation, and cross-reactivity between the virus and donor antigens. 20 – 22 However, there is growing interest in the drug interactions between ART, especially PIs and CNIs or mTORi.…”