Renal Transplantation in HIV‐Infected Patients: The Paris Experience

Abstract

Kidney transplantation is now considered as a reasonable option for HIV-infected patients with endstage renal disease. We describe here a retrospective study conducted in five transplantation centers in Paris. Twenty-seven patients were included. Immunosuppressive protocol associated an induction therapy and a long-term treatment combining mycophenolate mofetil, steroids and either tacrolimus or cyclosporine. All the patients had protocol biopsies at 3 months and 1 year. Patient's survival was 100% at 1 year and 98% at 2 years. Graft survival at 1 and 2 years is 98% and 96% at 1 and 2 years, respectively. The mean glomerular filteration rate values at 12 and 24 months were 60.6 mL/min/1.73 m 2 (range 23-98) and 65.4 mL/min/1.73m 2 (range 24-110), respectively. Acute cellular rejection was diagnosed in four cases (15%). Because of high trough levels of calcineurin inhibitor, protease-inhibitor therapies were withdrawn in 11 cases. HIV disease progression was not observed. One patient developed B-cell lymphoma.In conclusion, our study confirms the safety of renal transplantation in HIV-infected patients with few adverse events and a low incidence of acute rejection.

Renal Transplantation in HIV-Infected Patients: The First Portuguese Review

“…We report a rate of AR of 29.4%, slightly lower than that reported in the literature [12,13,15,16]. The European and US studies describe a 1-year graft survival between 90.4% and 98% [12,15,16].…”

“…In the United States, 83% of patients received induction therapy, 51% of them with anti-CD25 [15]. In a French series, 100% of patients received induction therapy [16]. All patients of our series received triple maintenance immunosuppressive therapy, which included tacrolimus.…”

Long-term outcome of ketoconazole and tacrolimus co-administration in kidney transplant patients

“…A dysregulated immune response in HIV-infected host was also proposed by others [6,7] . However, a French report showed similar rejection rates (15%) after kidney transplants in HIV-infected patients vs non-infected patients [22] . They attributed the lower rejection rate to the use of raltegravir (an integrase inhibitor)-based antiviral therapy, which does not inhibit P450 system.…”

The Kidney as a Reservoir for HIV-1 after Renal Transplantation

“…Since the recent publication of reports showing favorable outcomes, kidney transplantation has become a therapeutic option for these patients. [5][6][7] Most centers have defined eligibility criteria for transplantation such as a CD4 count .200 cells/ml and an undetectable plasma level of HIV RNA. 8 When using these criteria, the survival rate of HIV-infected transplant recipients is similar to that of non-HIV-infected transplant recipients, but intriguingly, the 3-year allograft survival rate is reduced among the HIV-infected transplant recipients.…”