Effect of Induction Therapy on CD4 Cell Count Recovery Following Renal Transplantation in HIV Positive Recipients – A Single Center Experience
Department of Transplantation, Mayo Clinic College of Medicine, Jacksonville, FL.
Meeting: 2018 American Transplant Congress
Abstract number: 214
Keywords: CD4, HIV virus, Induction therapy, Kidney transplantation
Session Information
Date: Monday, June 4, 2018
Session Name: Concurrent Session: Kidney Immunosuppression: Induction Therapy
Session Time: 2:30pm-4:00pm
Presentation Time: 3:06pm-3:18pm
Location: Room 6C
The feasibility, complications and outcomes of solid organ transplantation in the HIV positive population are well documented and have had excellent outcomes with a slight increased risk of rejection but no significant increase in the risk of opportunistic infections compared to non-HIV population. Basiliximab has been typically used for induction therapy in HIV positive organ recipients, but there is a paucity of data regarding the use of lymphocyte-depleting agents, in particular Alemtuzumab, and the effect on rates of recovery of CD4 counts, rates of rejection and opportunistic infection. We present data from a single center gathered from 14 HIV renal transplant recipients from 2012 to 2017.
Induction therapy was chosen based upon perceived immunologic risk of rejection using the same determinants (level DSA, age, cancer history) as for the non-HIV population at our institution. Six patients received Alemtuzumab (average risk), 3 Basiliximab (low risk) and 4 Thymoglobulin (high risk). Baseline CD4 counts were above 200 and all patients had undetectable viral load.
Results:
| Rejection | Serious Infection | Creatinine mg/dl | CD4 count | |
| alemtuzumab n=7 | Banff1B n=1, borderline ACR n=1 | nocardiosis n=1, Ocular VZV n=1 | 1-2.7 | no data, n=3; >150, n=3, 70 after ATG tx for rejection |
| thymoglobulin n=4 | Banff1A with TMA and graft loss n=1 | none | mean 1.2; graft loss excluded | 96-206 |
| basiliximab n=3 | borderline ACR n=1 | none | 0.7-1.3 | >200, n=3 |
Conclusions: Based on this small cohort, we conclude that lymphocyte depleting agents, including Alemtuzumab, are valid options for induction in HIV positive recipients undergoing renal transplantation. Regarding opportunistic infections, a case of disseminated nocardia occurred in the Alemtuzumab group only following treatment of rejection with ATG, with a downstream effect on CD4 count recovery by 12 months post transplantation. The case of shingles at 4 months when CD4 count was <100 prompted us to consider basing duration of anti-viral prophylaxis on CD4 count rather than standard duration as applied to the non-HIV positive transplant population. Overall, rates of recovery in CD4 counts were acceptable. Apart from a case of TMA that resulted in allograft loss, rejections were mild and overall graft function was acceptable.
CITATION INFORMATION: Chique Figueroa J., Prendergast M., Wadei H., Mai M., Oshel K., Leonard D. Effect of Induction Therapy on CD4 Cell Count Recovery Following Renal Transplantation in HIV Positive Recipients – A Single Center Experience Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Figueroa JChique, Prendergast M, Wadei H, Mai M, Oshel K, Leonard D. Effect of Induction Therapy on CD4 Cell Count Recovery Following Renal Transplantation in HIV Positive Recipients – A Single Center Experience [abstract]. https://atcmeetingabstracts.com/abstract/effect-of-induction-therapy-on-cd4-cell-count-recovery-following-renal-transplantation-in-hiv-positive-recipients-a-single-center-experience/. Accessed December 14, 2019.« Back to 2018 American Transplant Congress