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Kidney transplantation in HIV-infected individuals

Authors
Deirdre Sawinski, MD, FAST
Pablo Tebas, MD
Section Editors
Daniel C Brennan, MD, FACP
Paul E Sax, MD
Deputy Editors
Albert Q Lam, MD
Jennifer Mitty, MD, MPH

INTRODUCTION

Kidney transplantation is accepted as the ideal therapy for end-stage renal disease (ESRD). Human immunodeficiency virus (HIV) infection was traditionally considered an absolute contraindication for transplantation because of the concern that immunosuppression would accelerate HIV disease progression, resulting in increased mortality and a "waste" of organs [1].

Since potent antiretroviral therapy (ART) became widely available in 1996 [2], the prognosis of patients with HIV infection has dramatically improved. There have been significant decreases in morbidity and mortality, and, for many individuals with well-controlled viral replication, HIV is now a chronic, manageable disease [3,4].

Improvements in the long-term prognosis of those with HIV infection and studies demonstrating good outcomes with kidney transplantation have prompted many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection. A review of the issues surrounding kidney transplantation in HIV-infected patients is presented here.

An overview of kidney disease in HIV-infected patients and a discussion of HIV-associated nephropathy (HIVAN) are presented elsewhere. (See "Overview of kidney disease in HIV-positive patients" and "HIV-associated nephropathy (HIVAN)".)

EPIDEMIOLOGY AND OUTCOMES

Patient and graft survival

Pre-ART era — Renal transplantation among HIV-infected individuals prior to the introduction of potent antiretroviral therapy (ART) was associated with poor patient and allograft outcomes [5]. In many patients, HIV infection was only diagnosed retrospectively or acquired peritransplant by transfusion or transplantation with infected organs. The improvement in patient survival with ART called into question the previous policy of systematically denying transplantation to HIV-infected patients [1,6].

                           
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Literature review current through: Oct 2017. | This topic last updated: Oct 12, 2017.
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