Renal transplantation in HIV + patients: some discharges and infections, according to a preliminary experiment

HIV-infected patients on triple therapy for HIV can successfully receive a kidney transplant with a low rate of rejection and infections, shows a pioneering team.

Only a few teams have already reported data on renal transplantation in HIV + highly active antiretroviral therapy patients (HAART), with rates of acute rejection from 43% to 67%.

Dr. Scott Gruber of Harper University Hospital in Detroit (Michigan) and colleagues report their preliminary experience in the form of a retrospective study of eight patients with a median follow up of 15 months.

The immunosuppressive protocol includes an anti-IL-2 antibody induction basiliximab (Simulect *, Novartis) or daclizumab (Zenapax *, Roche), mycophenolate mofetil (Cellcept *, Roche), ciclosporin (250-300 ng / mL during the first three months, 225-275 3rd to 6th month, with a decline thereafter) and prednisone maintenance. The doses of cyclosporine and Cellcept * were adjusted closer to the target dose.

Patient survival was 100% and 88% of the graft with acute rejection rates of 13% and excellent renal function. A delayed recovery of the graft was observed in three patients (38%). One patient lost his graft 11 months after transplantation, after submitting a BK virus nephropathy, infection with cytomegalovirus (CMV) and acute rejection.

At this stage, no patient developed diabetes, opportunistic infections, other serious infections, tumors, progression of liver disease associated with hepatitis C.

The results of viral replication were excellent with maintenance of CD4 in all cases, the doctors note.

In addition, patients had multiple risk factors associated with a poorer evolution: a high proportion of African-American patients, a significant time spent on dialysis, a majority of co-infection with HCV, regardless of living donors and strong proportion of sensitized patients.

Compared to what has already been published, the rejection rate was very low, but the small number of patients, this result requires. For authors, it probably comes from the high dose of cyclosporine used initially and the adjustment made for Cellcept * to be closer to the target dose.