Purpose: Single center experience of kidney and pancreas transplantation in the HIV positive population

Methods: Retrospective data and outcomes analysis of HIV positive kidney and pancreas allograft recipients from 2012 to 2016. All patients had undetectable viral load and CD4 count >200 and induction agent prescribed was as per institutional protocol assessment of immunologic risk in non-HIV population. Patients HAART regimen was maintained intact.

Data:

Results: Mean serum creatinine at 1 year was 1.08 mg/dL. Kidney-pancreas recipient maintained euglycemia. CD4 counts fell to <50 copies/mL in all except the basiliximab-induced patient (maintained CD4>200) with no development of opportunistic infection. HIV RNA viral load remained undetectable in all but 1 patient. There were no serious infections or malignancy apart from one case of shingles. Mild BK nephropathy occurred in 1 patient. Two cases of borderline ACR and one Banff 1 rejection were successfully treated with steroids, and one graft was lost to TMA. There were no patient deaths.

Conclusions: Authors conclude that kidney and pancreas transplantation is feasible and successful, with acceptable graft function at 1 year and no increased risk of opportunistic infection despite sustained low CD4 counts (years). HIV RNA may become transiently positive at a low level but resolves quickly. Alemtuzumab and thymoglobulin are both well tolerated as induction agents. Consistent with previous findings, in this small patient cohort, rejection rates are higher with basiliximab induction. Protease inhibitors may contribute to the development of CNI changes on biopsy and demonstrate wide variability in levels causing dosing challenges. Consideration should be given to utilization of a non-PI based HAART regimens post-transplantation.

References:

1. Frassetto L et al. Renal transplantation in patients with HIV. Nat Rev Nephrol. 2009

2. Sharma A et al. Calcineurin inhibitor toxicity in renal allografts: morphologic clues from protocol biopsies. Indian J Pathol Microbiol. 2010

3. Stock P et al. Outcomes of Kidney Transplantation in HIV-infected recipients. N Engl J Med 2010.

CITATION INFORMATION: Leonard D, Prendergast M. Emerging Variables Which May Enhance Care of HIV Positive Renal Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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