Kidney transplants in HIV-positive recipients under HAART. A comprehensive review and meta-analysis of 12 series

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2010-09, Vol.25 (9), p.3106-3115
• Main Authors: Landin, Luis, Rodriguez-Perez, Jose C., Garcia-Bello, Miguel A., Cavadas, Pedro C., Thione, Alessandro, Nthumba, Peter, Blanes, Marino, Ibañez, Javier
• Format: Article
• Language: English
• Subjects: AIDS: acquired immune deficiency syndrome; AIN: anal intraepithelial neoplasia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antiretroviral Therapy, Highly Active; ATG: anti-thymocyte globulin; Biological and medical sciences; CI: confidence interval; CMV: cytomegalovirus; CsA: cyclosporine A; EBV: Epstein–Barr virus; Emergency and intensive care: renal failure. Dialysis management; Graft Rejection - prevention & control; Graft Survival; HAART; HAART: highly active antiretroviral therapy; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Seropositivity; HIV-1 - immunology; HIV: human immunodeficiency virus; HIVAN: HIV-associated nephropathy; HPV: human papillomavirus; Human immunodeficiency virus; Humans; Intensive care medicine; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - therapy; Kidney Transplantation; Medical sciences; MMF: mycophenolate mofetil; Prospective Studies; PTLD: post-transplant lymphoproliferative disease; review; Review Literature as Topic; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate; Treatment Outcome
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfq125

Background. Kidney transplantation is being introduced gradually for the treatment of end-stage renal disease in patients who are human immunodeficiency virus (HIV) positive. Our aim was to review the outcomes of kidney transplantation in HIV-positive recipients who were being treated with highly active antiretroviral therapy (HAART). Methods. Eligible papers were English language manuscripts, published between July 2003 and April 2009 and available through Medline, that described three or more recipients of kidney transplants who were HIV positive and undergoing HAART. The regimens for induction and maintenance therapy, organ rejection, patient survival, CD4 counts, HIV progression, infectious complications and deaths were recorded. The survival at 1 year, organ rejection and infectious complications were evaluated using a random effects model with 95% confidence intervals (CI). Results. Twelve case series met the defined criteria. Induction therapy consisted most commonly of the administration of anti-CD25 monoclonal antibodies, and triple immunosuppressive therapy was used most commonly for maintenance. Among the 254 patients, 1-year survival was 0.93 (95% CI, 0.90–0.96), organ rejection was diagnosed in 0.36 (95% CI, 0.25–0.49) and infectious complications occurred in 0.29 (95% CI, 0.17–0.43). The CD4 counts decreased after transplantation but recovered later. Acquired immune deficiency syndrome (AIDS)-defining infections occurred in three patients. Conclusions. Kidney transplantation appears to be safe in patients undergoing HAART. However, larger series of patients are needed to determine the best protocols for the induction and maintenance of immunosuppression.