Kidney transplantation in HIV-infected individuals
- Deirdre Sawinski, MD, FAST
Deirdre Sawinski, MD, FAST
- Assistant Professor of Medicine
- Assistant Medical Director, Kidney Pancreas Transplantation
- Renal Electrolyte and Hypertension Division
- Hospital of the University of Pennsylvania
- Pablo Tebas, MD
Pablo Tebas, MD
- Professor of Medicine
- University of Pennsylvania
- Section Editors
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
- Paul E Sax, MD
Paul E Sax, MD
- Section Editor — HIV
- Clinical Director, Division of Infectious Diseases
- Brigham and Women's Hospital
- Professor of Medicine
- Harvard Medical School
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 .
Since potent antiretroviral therapy (ART) became widely available in 1996 , 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 . 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].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EPIDEMIOLOGY AND OUTCOMES
- Patient and graft survival
- - Pre-ART era
- - Transplantation in the ART era
- Risk of rejection
- Infection risk
- ELIGIBILITY CRITERIA
- PHARMACOLOGIC MANAGEMENT
- Management of immunosuppression
- - Induction therapy
- - Maintenance therapy
- Management of antiretroviral therapy
- - Drug interactions
- MONITORING AFTER TRANSPLANTATION
- Renal allograft function
- HIV viral control
- PROPHYLAXIS AFTER TRANSPLANTATION
- POSTTRANSPLANT COMPLICATIONS
- HIV infection of the allograft
- Opportunistic infections
- Delayed graft function
- SPECIAL CONSIDERATIONS
- HIV-infected donors
- Coinfection with HBV or HCV
- - HBV infection
- - HCV infection
- FUTURE DIRECTIONS
- SUMMARY AND RECOMMENDATIONS