Kidney Transplants Found Safe in HIV Patients

HIV-infected patients who received kidney transplantation had high patient and organ survival rates at both the first and third year after the surgery, a new study shows.

An increasing number of people with HIV have end-stage renal disease (ESRD), despite the efficacy of highly active antiretroviral therapy in reducing HIV-related kidney disease, noted the study's lead author from the University of California-San Francisco, Dr. Peter Stock, and colleagues. "In the United States and Europe, nearly 1 percent of patients with ESRD are infected with HIV, and HIV-associated nephropathy is the third most common cause of ESRD among blacks in the United States who are between 20 and 64 years of age," they wrote.

In the non-randomized trial, the researchers studied the safety and efficacy of renal transplantation in 150 HIV-positive recipients from 19 US medical centers. Patient survival rates were 94.6 percent one year after transplantation and 88.2 percent after three years. Organ survival rates were 90.4 percent and 73.7 percent at years one and three.

"A multivariate proportional-hazards analysis showed that the risk of graft loss was increased among patients treated for rejection (hazard ratio [HR], 2.8; 95 percent confidence interval [CI], 1.2-6.6; P=0.02) and those receiving antithymocyte globulin induction therapy (HR, 2.5; 95 percent CI, 1.1-5.6; P=0.03); living-donor transplants were protective (HR, 0.2; 95 percent CI, 0.04-0.8; P=0.02)," the study found.

"The rates of patient survival and graft survival at three years were generally between the reported rates in the national database for older kidney transplant recipients (=65 years of age) and for all kidney transplant recipients," the authors reported.

Rejection rates were about two to three times higher than usual, indicating the need for better immunotherapy, wrote Stock and colleagues. "It's not that dramatic and we've been able to reverse them," Stock said. "But we know that each rejection episode takes a little bit of life out of the kidney. So instead of lasting 20 years, it might last 15 years. That's why it's very important to figure that out."

The study, "Outcomes of Kidney Transplantation in HIV-Infected Recipients," was published in the New England Journal of Medicine (2010;363:2004-2014).

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