Journal article
Outcomes of Kidney Transplantation in HIV-Infected Recipients
The New England journal of medicine, v 363(21), pp 2004-2014
18 Nov 2010
PMCID: PMC3028983
PMID: 21083386
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND
The outcomes of kidney transplantation and immunosuppression in people infected with human immunodeficiency virus (HIV) are incompletely understood.
METHODS
We undertook a prospective, nonrandomized trial of kidney transplantation in HIV-infected candidates who had CD4+ T-cell counts of at least 200 per cubic millimeter and undetectable plasma HIV type 1 (HIV-1) RNA levels while being treated with a stable antiretroviral regimen. Post-transplantation management was provided in accordance with study protocols that defined prophylaxis against opportunistic infection, indications for biopsy, and acceptable approaches to immunosuppression, management of rejection, and antiretroviral therapy.
RESULTS
Between November 2003 and June 2009, a total of 150 patients underwent kidney transplantation; survivors were followed for a median period of 1.7 years. Patient survival rates (+/- SD) at 1 year and 3 years were 94.6 +/- 2.0% and 88.2 +/- 3.8%, respectively, and the corresponding mean graft-survival rates were 90.4% and 73.7%. In general, these rates fall somewhere between those reported in the national database for older kidney-transplant recipients (>= 65 years) and those reported for all kidney-transplant recipients. A multivariate proportional-hazards analysis showed that the risk of graft loss was increased among patients treated for rejection (hazard ratio, 2.8; 95% confidence interval [CI], 1.2 to 6.6; P = 0.02) and those receiving antithymocyte globulin induction therapy (hazard ratio, 2.5; 95% CI, 1.1 to 5.6; P = 0.03); living-donor transplants were protective (hazard ratio, 0.2; 95% CI, 0.04 to 0.8; P = 0.02). A higher-than-expected rejection rate was observed, with 1-year and 3-year estimates of 31% (95% CI, 24 to 40) and 41% (95% CI, 32 to 52), respectively. HIV infection remained well controlled, with stable CD4+ T-cell counts and few HIV-associated complications.
CONCLUSIONS
In this cohort of carefully selected HIV-infected patients, both patient-and graft-survival rates were high at 1 and 3 years, with no increases in complications associated with HIV infection. The unexpectedly high rejection rates are of serious concern and indicate the need for better immunotherapy.
Metrics
Details
- Title
- Outcomes of Kidney Transplantation in HIV-Infected Recipients
- Creators
- Peter G. Stock - University of California, San FranciscoBurc Barin - Emmes CorporationBarbara Murphy - Icahn School of Medicine at Mount SinaiDouglas Hanto - Harvard UniversityJorge M. Diego - University of MiamiJimmy Light - MedStar Washington Hospital CenterCharles Davis - University of Maryland, BaltimoreEmily Blumberg - University of PennsylvaniaDavid Simon - Rush UniversityAruna Subramanian - Johns Hopkins UniversityJ. Michael Millis - University of ChicagoG. Marshall Lyon - Emory UniversityKenneth Brayman - University of VirginiaDoug Slakey - Tulane UniversityRon Shapiro - University of PittsburghJoseph Melancon - Georgetown UniversityJeffrey M. Jacobson - Drexel UniversityValentina Stosor - Northwestern UniversityJean L. Olson - University of California, San FranciscoDonald M. Stablein - Emmes CorporationMichelle E. Roland - University of California, San Francisco
- Publication Details
- The New England journal of medicine, v 363(21), pp 2004-2014
- Publisher
- Massachusetts Medical Soc
- Number of pages
- 11
- Grant note
- U01 AI052748; U01 AI052748-08; AI052748 / NIAID NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) U01AI052748 / NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID)
- Resource Type
- Journal article
- Language
- English
- Web of Science ID
- WOS:000284310000005
- Scopus ID
- 2-s2.0-78549288927
- Other Identifier
- 991019335229304721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- Web of Science research areas
- Immunology