Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
- Incidence of Acute Rejection and Donor Specific Antibodies in Low-Immunological Risk Patients Treated by Tacrolimus and Mycophenolic Acid with or without Induction Therapy.
- Better Long-Term Renal Function with Lower Incidence of Acute Rejection and Lower CMV Infection in Renal Transplant Patients Treated with a Combination of Tacrolimus and Everolimus.
Renal transplantation is safe and effective in HIV patients with end stage renal disease (ESRD). High rates of acute rejection (AR) have been reported because of ntiretroviral (ARV) and immunosuppressive treatments interactions through CYP450 metabolization. Raltegravir (RAL) is not a substrate of CYP450 enzymes. We conducted a trial to determine incidence of clinical AR in HIV recipients treated with RAL.
The ANRS 153 TREVE (NCT01453192) was a national multicenter prospective open label single arm trial in adult HIV ESRD patients awaiting transplant, with controlled viral load, CD4 count >200/[micro]L and stable ARV regimen for at least 3 months, and viruses sensitive to RAL. After transplant, the ARV regimen included RAL. The trial aimed to demonstrate that the clinical AR rate was below 30%. A blind pathologist reviewed all biopsies. We assessed patient survival on the waiting-list, after transplant and, allograft survival compared to a control group of HIV-negative recipients matched on age, sex and date of registration on the waiting list.
Between 12/2011 and 12/2014, 26 HIV ESRD patients enrolled in the trial underwent renal transplantation. Median age was 48 years, 69% were male and 62% were from Sub-Saharan Africa. Median CD4 count was 387/[micro]L. AR occurred in 2 patients, leading to 8% rejection at 6 and 12 months (95%CI: 2–24). One subclinical rejection occurred 10 days after transplant. The 3-year survival on the waiting-list was 100% in HIV patients compared to 87% in controls (p=0.031). After transplant, the 3-year survival was similar in both groups; 89% and 96% (p=0.197). Three-years allograft survival was similar in both groups; 92% and 87% (p=0.415). HIV infection remained controlled in all patients except one who discontinued ARV. Another patient, with a prior AIDS event, developed a Kaposi Sarcoma.
After kidney transplantation, ARV including RAL is effective to prevent AR. Patients and kidney allograft survivals are similar to HIV negative recipients.
CITATION INFORMATION: Matignon M, Lahiani A, Lelievre J, Desvaux D, Abassi K, Diallo A, Peraldi M, Taburet A, Saillard J, Delaugerre C, Assoumou L, Grimbert P, TREVE ANRS Study Group Low Incidence of Acute Rejection within the Six Months After Transplantation in HIV Recipients Treated with Raltegravir, the ANRS 153 Treve Trial. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Matignon M, Lahiani A, Lelievre J, Desvaux D, Abassi K, Diallo A, Peraldi M, Taburet A, Saillard J, Delaugerre C, Assoumou L, Grimbert P, Group TREVEANRSStudy. Low Incidence of Acute Rejection within the Six Months After Transplantation in HIV Recipients Treated with Raltegravir, the ANRS 153 Treve Trial. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/low-incidence-of-acute-rejection-within-the-six-months-after-transplantation-in-hiv-recipients-treated-with-raltegravir-the-anrs-153-treve-trial/. Accessed January 16, 2021.
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