Longer-Term Outcomes of HIV-Positive–to–HIV-Positive Renal Transplantation

Selhorst, Philippe; Combrinck, Catharina E.; Manning, Kathryn; Botha, Francois Cj; Labuschagne, Jan Phillipus Lourens; Anthony, Colin; Matten, David; Breaud, Autumn; Clarke, William; Quinn, Thomas C.; Redd, Andrew D.; Williamson, Carolyn; Muller, Elmi

doi:10.1056/nejmc1903013

Cited by 47 publications

(43 citation statements)

References 5 publications

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“…The most extensive experience in the use of HIV1 kidney donors comes from South Africa. To date they have transplanted 51 recipients of HIV1 donor kidneys (14); outcomes have been comparable to those observed in HIV1 recipients of HIV2 donor organs, with 1-year patient survival of 87% and 1-year death-censored allograft survival of 96%. Of note, the South African experience is somewhat unique: the vast majority of donors with HIV are young trauma victims and most are either not on ART or only first-line therapy.…”

Section: Unique Transplant Opportunities: Hiv1 To Hiv1 Kidney Transplmentioning

confidence: 87%

Kidney Transplantation in Patients with HIV

Sawinski

2020

Kidney360

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Individuals with HIV are at increased risk for ESKD. Kidney transplantation is the best treatment for ESKD in the HIV+ population. Despite reduced access to transplantation, patients who are HIV+ have excellent outcomes and clearly benefit from receiving one. Common post-transplant complications and management concerns, including the optimal antiretroviral regimen, immunosuppression protocols, infectious prophylaxis, hepatitis C coinfection, metabolic complications, and malignancy are all discussed.

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Section: Unique Transplant Opportunities: Hiv1 To Hiv1 Kidney Transplmentioning

confidence: 87%

Kidney Transplantation in Patients with HIV

Sawinski

2020

Kidney360

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“…Using kidneys from HIV+ kidney donors may be an option in HIV+ recipients. The longest experience using HIV+ donors comes from South Africa 37‐39 . Muller pioneered transplantation with kidneys from deceased HIV+ donors, using lymphocyte‐depleting induction and tacrolimus‐based immunosuppression 6 .…”

Section: Hiv and Eskdmentioning

confidence: 99%

“…Muller pioneered transplantation with kidneys from deceased HIV+ donors, using lymphocyte‐depleting induction and tacrolimus‐based immunosuppression 6 . Outcomes have generally been good, with death‐censored graft survival was 93% at 3 years (95% CI 79‐98) and 79% at 5 years (95% CI 58‐91); patient survival was 87% at 3 years (95% CI 74‐94) and 84% at 5 years (95% CI 68‐92) 39 . While these results are encouraging, the South African experience is unique; HIV drug resistance is rare; and most donors were ARV naïve, young trauma victims, quite different from the potential HIV+ donors in the United States.…”

Section: Hiv and Eskdmentioning

confidence: 99%

Current state of kidney transplantation in patients with HIV, hepatitis C, and hepatitis B infection

Sawinski

Wong

Goral

2020

Clinical Transplantation

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Human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) are common chronic viral infections in the end‐stage kidney disease (ESKD) patient population that were once considered relative contraindications to kidney transplantation. In this review, we will summarize the current state of kidney transplantation in patients with HIV, HCV, and HBV, which is rapidly evolving. HIV+ patients enjoy excellent outcomes in the modern transplant era and may have new transplant opportunities with the use of HIV+ donors. Direct‐acting antivirals for HCV have substantially changed the landscape of care for patients with HCV infection. HBV+ patients now have excellent patient and allograft survival with HBV therapy. Currently, kidney transplantation is a safe and appropriate treatment for the majority of ESKD patients with HIV, HCV, and HBV.

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“…The incidence of recurrent HIV nephropathy following transplantation has been reported with variable frequencies. In the South African program, 51 patients received 150 protocol as well as "for cause" biopsies over a 10-year period [26]. Twelve patients had some features of HIVAN on a protocol biopsy.…”

Section: Recurrence Of Hivanmentioning

confidence: 99%

“…2 Example of plasma cell infiltrate, podocyte hypertrophy, end-stage glomeruli, and focal segmental glomerulosclerosis. Despite these changes, patient has excellent graft function and recipient samples were evaluated for HIV drug-resistant mutations pre-and/or post-transplant [26]. Although drug-resistant mutations were found in six recipients, none of these mutations was donor derived.…”

Section: Second Viral Strainmentioning

confidence: 99%

Solid Organ Transplantation in HIV Positive Patients

Muller

Stock

2020

Emerging Transplant Infections

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Transplantation in recent years has become a viable option to treat end stage organ failure in people living with HIV infection. Significant advances in the understanding of appropriate immunosuppression management and infection prevention have resulted in graft and patient survival comparable to HIV-negative recipients in many cases. Given the higher incidence of end stage organ disease in HIV positive patients, particularly liver cirrhosis and dialysis dependent renal failure, transplant should be considered as a viable pathway for these patients. Furthermore, encouraging results are starting to emerge regarding using HIVpositive organ donors, both living and deceased.

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Longer-Term Outcomes of HIV-Positive–to–HIV-Positive Renal Transplantation

Cited by 47 publications

References 5 publications

Kidney Transplantation in Patients with HIV

Kidney Transplantation in Patients with HIV

Current state of kidney transplantation in patients with HIV, hepatitis C, and hepatitis B infection

Solid Organ Transplantation in HIV Positive Patients

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