Renal transplantation in human immunodeficiency virus-infected recipients: a case-control study from the Brazilian experience

• Published in: Transplant infectious disease Vol. 18; no. 5; pp. 730 - 740
• Main Authors: Vicari, A.R., Spuldaro, F., Sandes-Freitas, T.V., Cristelli, M.P., Requião-Moura, L.R., Reusing Jr, J.O., Pierrotti, L.C., Oliveira, M.L., Girão, C.M., Gadonski, G., Kroth, L.V., Deboni, L.M., Ferreira, G.F., Tedesco-Silva, H., Esmeraldo, R., David-Neto, E., Saitovitch, D., Keitel, E., Garcia, V.D., Pacheco-Silva, A., Medina-Pestana, J.O., Manfro, R.C.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01-10-2016; Wiley Subscription Services, Inc
• Subjects: Adult; Antilymphocyte Serum - administration & dosage; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Brazil - epidemiology; Case-Control Studies; Coinfection - epidemiology; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - epidemiology; Epidemiology; Female; Glomerular Filtration Rate; graft rejection; Graft Rejection - epidemiology; Graft Survival; Hepacivirus - isolation & purification; Hepatitis C - epidemiology; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - mortality; Human immunodeficiency virus; Humans; Immunosuppression - methods; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Incidence; Infections; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - surgery; Kidney transplantation; Kidney Transplantation - mortality; Male; Middle Aged; Patients; Retrospective Studies; survival analysis; Survival Rate; Transplant Recipients; Transplants & implants; Treatment Outcome; graft survival; human immunodeficiency virus; graft rejection; survival analysis; kidney transplantation
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12592

Background
Highly active antiretroviral therapy has turned human immunodeficiency virus (HIV)‐infected patients with end‐stage renal disease into suitable candidates for renal transplantation. We present the Brazilian experience with kidney transplantation in HIV‐infected recipients observed in a multicenter study.
Methods
HIV‐infected kidney transplant recipients and matched controls were evaluated for the incidence of delayed graft function (DGF), acute rejection (AR), infections, graft function, and survival of patients and renal grafts.
Results
Fifty‐three HIV‐infected recipients and 106 controls were enrolled. Baseline characteristics were similar, but a higher frequency of pre‐transplant positivity for hepatitis C virus and cytomegalovirus infections was found in the HIV group. Immunosuppressive regimens did not differ, but a trend was observed toward lower use of anti‐thymocyte globulin in the group of HIV‐infected recipients (P = 0.079). The HIV‐positive recipient group presented a higher incidence of treated AR (P = 0.036) and DGF (P = 0.044). Chronic Kidney Disease Epidemiology Collaboration estimated that glomerular filtration rate was similar at 6 months (P = 0.374) and at 12 months (P = 0.957). The median number of infections per patient was higher in the HIV‐infected group (P = 0.018). The 1‐year patient survival (P < 0.001) and graft survival (P = 0.004) were lower, but acceptable, in the group of HIV‐infected patients.
Conclusions
In the Brazilian experience, despite somewhat inferior outcomes, kidney transplantation is an adequate therapy for selected HIV‐infected recipients.