Introduction

Kidney transplantation in HIV+ individuals has been associated with patient and graft survival rates that are comparable to those reported for HIV- populations. Despite this success, there are a number of well-reported complexities that must be managed in order to achieve this success. Less is known, however about how the transplant evaluation and listing process may differ for HIV+ patients.

Methods

We performed a single center chart review of consecutive patients who were listed from January 1, 2010 to April 30, 2014 in order to better understand the process and timing of kidney transplant evaluation. We focused on features related to the HIV therapy including cART (combination antiretroviral therapy), co-morbidities, and timing of listing.

Results

Forty-four patients were evaluated. The median age of the cohort was 53 years old and 86% were African-American. At the time of evaluation, 91% were already receiving dialysis at a median of close to two years (624 days, IQR 115, 1435). Among the patients listed (status 7), three quarters completed the work up and were activated. The median time to be on active on the transplant list from the point of evaluation was 235 days (IQR 91, 578). One patient in five had viral hepatitis and only two (5%) had a history of opportunistic infection. HIV infections were relatively well controlled with median CD4 count of 561 cells/mm3 and 88% had controlled viremia. A resistance profile was available for only a small group (5%). Close to half of the patients (46%) were taking a protease-based cART.

Discussion

In our cohort HIV+ patient who were evaluated and listed for kidney transplantation the majority were on dialysis at the time of initial presentation and required a prolonged time to complete the evaluation. We found that the majority of patients were treated with cART that had interactions with immunosuppressive drugs. Successful evaluation and transplantation of HIV+ patients requires a coordinated multidisciplinary effort. To improve this process we suggest (1) early referral of HIV infected patients to centers performing HIV transplantation, (2) establish a support system to accelerate the evaluation process, and (3) work closely with HIV health-providers to adjust cART and obtain accurate information that might be critical for future transplantation.

« Back to 2015 American Transplant Congress