Date: Tuesday, June 14, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 5:18pm-5:30pm
Location: Ballroom A
Several studies reported reduced renal allograft survival rates among HIV-infected transplant recipients. Few data focus on histological lesions and their progression in renal grafts from these patients.
We included retrospectively 32 HIV-positive patients who received a kidney transplant in our center. We analyzed all the “for cause” and protocol biopsies (105 graft biopsies) performed at day 0, 3 months and 1 year after transplantation. Patients were divided in 2 groups according to their initial kidney disease: HIVAN (n=11) and non-HIVAN (n=22). Patient and graft survival, as well as renal function and immunosuppressive ant anti-retroviral treatments were analyzed.
The median follow-up was 5.1 years (1.8 – 10.2 yrs). At last follow-up, 87.5% of patients were alive and 81% had a functional graft. Patient and graft survival was identical in patients with or without HIVAN. Eleven patients (34%) had acute rejection: 3 borderline lesions, 2 acute cellular rejection, and 6 acute humoral rejection. Measured GFR at 1 year was significantly higher in non-HIVAN patients (50.4 ± 12.8 vs 37.4 ± 15.0 mL/min/1.73 m2, P=0.005). Preimplantation biopsies and protocol biopsies performed at 3 months and 1 year were analyzed: mean interstitial fibrosis (IF) and tubular atrophy (TA) scores in the renal grafts increased significantly (from 0.4 ± 0.4 to 1.4 ± 0.7, P=0.01) between day 0 and 1 year in the group of patients with history of HIVAN, and chronic vascular disease showed an accelerated progression in these patients (from 0.6 ± 0.5 to 1.2 ± O.6, P=0.02). In 4 cases, renal biopsy, performed because of increasing proteinuria , showed a collapsing form of FSGS, associated with tubulo-interstitial disease in two cases after a median time of 26.5 months (range: 9.2 – 70.0).
Patients with previous HIVAN have a higher incidence rate of renal graft fibrosis and chronic vascular lesions than non-HIVAN HIV-positive kidney-transplant recipients. Recurrence of collapsing FSGS is a late frequent event in patients who had previous HIVAN. Further studies are required to elucidate the mechanisms leading to this accelerated graft fibrosis.
CITATION INFORMATION: Peraldi M.-N, Ayari H, Burbach M, Randoux C, Pillebout E, De Castro N, Molina J.-M, Glotz D. Lower Renal Graft Function and Accelerated Fibrosis in HIV-Infected Transplant Recipients with Previous HIVAN Compared to Non HIVAN HIV-Positive Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Peraldi M-N, Ayari H, Burbach M, Randoux C, Pillebout E, Castro NDe, Molina J-M, Glotz D. Lower Renal Graft Function and Accelerated Fibrosis in HIV-Infected Transplant Recipients with Previous HIVAN Compared to Non HIVAN HIV-Positive Transplant Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/lower-renal-graft-function-and-accelerated-fibrosis-in-hiv-infected-transplant-recipients-with-previous-hivan-compared-to-non-hivan-hiv-positive-transplant-recipients/. Accessed March 6, 2021.
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