NIV Congres

Introduction Following the introduction of highly active antiretroviral therapy, life expectancy of HIV patients has improved and chronic complications such as kidney failure are seen more frequently. As a result an increasing number of HIV patients is accepted for kidney transplantation. The need for both sufficient immune suppression and HIV control gives rise to problems not encountered in the HIV negative population. Here we evaluate the outcome of all HIV positive patients who underwent a kidney transplantation in The Netherlands.

Methods We retrospectively collected data up to August 2012 from patient files and hospital databases in the five university medical centers where HIV positive patients had received a kidney transplantation. The outcomes were compared to those described in international literature. Results are reported as median with their corresponding range.

Results 21 HIV positive patients have been transplanted in The Netherlands. 17 were male, 7 were Caucasian, 12 African and 2 African-American. Age at transplantation was 45 yrs (26-65), with a history of 5.0 yrs (0.2-10.2) of kidney replacement therapy. Pre-transplantation CD4 count was 470 cells/mm3 (190-1318), plasma HIV RNA was undetectable (< 50 copies/mL) in all but one patient. Post-transplantation follow-up at the time of analysis was 2.3 years (0.4-17.6), patient and death-censored graft survival were 85.7% and 90.5%, respectively. Delayed graft function was present in 7 patients (33%), with a median of 14 days (5-51).  There have been 7 viral reactivations, 1 opportunistic infection, 1 Kaposi sarcoma and 1 PTLD. 10 patients suffered a total of 14 acute rejections. Creatinine at 6, 12 and 18 months after transplantation was 160 (57-215), 152 (76-365) and 170 (78-346) umol/L respectively. CD4 count at 6, 12 and 18 months was 248 (70-699), 255 (120-693) and 309 (87-597) cells/mm3. One patient showed HIV virological failure due to poor drug compliance, 3 others had transient low level viremia or viral blips.

Conclusion In our cohort we find excellent patient and graft survival with a high rejection rate, which is comparable to results reported in literature. Good survival and the absence of serious HIV-related morbidity support the eligibility of HIV positive patients for kidney transplantation.