HIV-positive-to-HIV-positive kidney transplantation

Abstract

BACKGROUND: The outcome of kidney transplantation in human immunodeficiency virus (HIV)–positive patients who receive organs from HIV-negative donors has been reported to be similar to the outcome in HIV-negative recipients. We report the outcomes at 3 to 5 years in HIV-positive patients who received kidneys from HIV-positive deceased donors.

METHODS: We conducted a prospective, nonrandomized study of kidney transplantation in HIV-infected patients who had a CD4 T-cell count of 200 per cubic millimeter or higher and an undetectable plasma HIV RNA level. All the patients were receiving antiretroviral therapy (ART). The patients received kidneys from deceased donors who tested positive for HIV with the use of fourth-generation enzyme-linked immunosorbent assay at the time of referral. All the donors either had received no ART previously or had received only first-line ART.

RESULTS: From September 2008 through February 2014, a total of 27 HIV-positive patients underwent kidney transplantation. Survivors were followed for a median of 2.4 years. The rate of survival among the patients was 84% at 1 year, 84% at 3 years, and 74% at 5 years. The corresponding rates of graft survival were 93%, 84%, and 84%. (If a patient died with a functioning graft, the calculation was performed as if the graft had survived.) Rejection rates were 8% at 1 year and 22% at 3 years. HIV infection remained well controlled, with undetectable virus in blood after the transplantation.

CONCLUSIONS: Kidney transplantation from an HIV-positive donor appears to be an additional treatment option for HIV-infected patients requiring renal-replacement therapy. (Funded by Sanofi South Africa and the Roche Organ Transplantation Research Foundation.)

Figure 1. Graft and Patient Survival among 27 Human Immunodeficiency Virus (HIV)–Positive Patients Who Received Kidney Transplants from HIV-Positive Donors

Data on graft survival were censored (tick marks) at the time of the patient’s death. The analysis of graft survival followed individual kidney transplants until graft failure occurred. If a patient died with a functioning graft, the calculation was done as if the graft had survived. regimen, five of whom had evidence on renal biopsy of calcineurin-inhibitor toxicity.