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Milosh B, Bugaighis M, Cervia J. Systematic review of the impact of protease-inhibitor-based combination antiretroviral therapy on renal transplant outcomes in recipients living with HIV infection. J Investig Med 2024:10815589241252595. [PMID: 38666448 DOI: 10.1177/10815589241252595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Advances in human immunodeficiency virus (HIV) treatment, including combination antiretroviral therapy (cART), have transformed HIV into a chronic condition. Kidney diseases cause morbidity and mortality in patients living with HIV (PLWH), though cART has permitted kidney transplants with acceptable post-transplant graft and patient survival. Risk of allograft rejection remains high, which may be related to interactions between cART, specifically protease inhibitors (PI), and immunosuppressants prescribed post-transplant. This systematic review evaluates renal transplant outcomes in PLWH treated with PI- vs non-PI-based cART. A search strategy was generated with terms related to renal transplant, HIV, and cART and run on PubMed, Embase, Scopus, and Cochrane. Studies were evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on Covidence by two reviewers and then evaluated for bias. Of 803 studies, 9 were included. Included papers were prospective or retrospective cohort studies or chart reviews of adult patients. Outcome measures included acute graft rejection, graft survival, and patient survival. One study had significant results demonstrating that PI-based therapy was correlated with increased graft rejection rates. Two studies demonstrated significant graft survival benefit to non-PI-based therapy, while one demonstrated significant benefit to PI-based therapy. Two studies found significant patient survival benefit to non-PI-based therapy. For each outcome measure, remaining data suggested improved outcomes with non-PI-based therapies without achieving statistical significance. The results demonstrate superior outcomes in PLWH taking non-PI-based cART, though the paucity of significant results suggests that PLWH who require PI-based cART for virological control may continue their regimen safely post-kidney transplant.
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Affiliation(s)
- Brooke Milosh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Mona Bugaighis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joseph Cervia
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Division of Infectious Diseases, Departments of Medicine and Pediatrics, Center for AIDS Research and Treatment, Northwell Health, New Hyde Park, NY, USA
- HealthCare Partners IPA and MSO, Garden City, NY, USA
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2
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Elalouf A. Infections after organ transplantation and immune response. Transpl Immunol 2023; 77:101798. [PMID: 36731780 DOI: 10.1016/j.trim.2023.101798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/08/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
Organ transplantation has provided another chance of survival for end-stage organ failure patients. Yet, transplant rejection is still a main challenging factor. Immunosuppressive drugs have been used to avoid rejection and suppress the immune response against allografts. Thus, immunosuppressants increase the risk of infection in immunocompromised organ transplant recipients. The infection risk reflects the relationship between the nature and severity of immunosuppression and infectious diseases. Furthermore, immunosuppressants show an immunological impact on the genetics of innate and adaptive immune responses. This effect usually reactivates the post-transplant infection in the donor and recipient tissues since T-cell activation has a substantial role in allograft rejection. Meanwhile, different infections have been found to activate the T-cells into CD4+ helper T-cell subset and CD8+ cytotoxic T-lymphocyte that affect the infection and the allograft. Therefore, the best management and preventive strategies of immunosuppression, antimicrobial prophylaxis, and intensive medical care are required for successful organ transplantation. This review addresses the activation of immune responses against different infections in immunocompromised individuals after organ transplantation.
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Affiliation(s)
- Amir Elalouf
- Bar-Ilan University, Department of Management, Ramat Gan 5290002, Israel.
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3
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Health-related quality of life and associated factors in HIV-positive transplant candidates and recipients from a HIV-positive donor. Qual Life Res 2022; 31:171-184. [PMID: 34156597 DOI: 10.1007/s11136-021-02898-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION HRQOL in transplant candidates and recipients who are also infected with HIV and are awaiting a kidney, or have received one from a HIV-positive donor, has not been previously investigated. METHODS The HRQOL of 47 HIV-positive kidney transplant candidates and 21 recipients from HIV-positive donors was evaluated using the Short Form-36 (SF-36) and face to face interviews at baseline and at 6 months. The correlation between SF-36 scores and sociodemographic, clinical and nutritional factors was determined. RESULTS 68 patients completed the SF-36 at baseline and 6 months. Transplant candidates: transplant candidates had lower HRQOL than recipients. The main mental stressors were income, employment and waiting for a donor. Physical health complaints were body pain (BP) and fatigue. Pre-albumin and BMI was positively correlated with general health at baseline (r = 0.401, p = 0.031 and r = 0.338, p = 0.025). Besides a positive association with role physical (RP) and BP, albumin was associated with overall physical composite score (PCS) (r = 0.329, p = 0.024) at 6 months. Transplant recipients: Transplant recipients had high HRQOL scores in all domains. PCS was 53.8 ± 10.0 and 56.6 ± 6.5 at baseline and 6 months respectively. MCS was 51.3 ± 11.5 and 54.2 ± 8.5 at baseline and 6 months respectively. Albumin correlated positively with PCS (r = 0.464, p = 0.034) at 6 months and role emotional (RE) (r = 0.492, p = 0.024). Higher pre-albumin was associated with better RE and RP abilities and MCS (r = 0.495, p = 0.034). MAMC was associated with four domains of physical health and strongly correlated with PCS (r = 0.821, p = 0.000). CONCLUSION Strategies to improve HRQOL include ongoing social support, assistance with employment issues and optimising nutritional status.
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Wairimu F, Ward NC, Liu Y, Dwivedi G. Cardiac Transplantation in HIV-Positive Patients: A Narrative Review. J Acquir Immune Defic Syndr 2021; 87:763-768. [PMID: 33534274 DOI: 10.1097/qai.0000000000002647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Before the introduction of highly active antiretroviral therapy, patients infected with HIV experienced poor prognosis including high rates of opportunistic infections, rapid progression to AIDS, and significant mortality. Increased life expectancy after therapeutic improvements has led to an increase in other chronic diseases for these patients, including cardiovascular disease and, in particular, end-stage heart failure. Historically, HIV infection was deemed an absolute contraindication for transplantation. Since the development of highly active antiretroviral therapy, however, life expectancy for HIV-positive patients has significantly improved. In addition, there is a low incidence of opportunistic infections and the current antiretrovirals have an improved toxicity profile. Despite this, the current status of cardiac transplants in HIV-positive patients remains unclear. With this in mind, we conducted a narrative review on cardiac transplantation in patients with HIV.
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Affiliation(s)
- Faith Wairimu
- Harry Perkins Institute for Medical Research, Fiona Stanley Hospital, Perth Australia
| | - Natalie C Ward
- School of Medicine, University of Western Australia, Perth Australia ; and
- The Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | - Yingwei Liu
- The Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | - Girish Dwivedi
- Harry Perkins Institute for Medical Research, Fiona Stanley Hospital, Perth Australia
- School of Medicine, University of Western Australia, Perth Australia ; and
- The Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
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5
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Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. J Assoc Nurses AIDS Care 2021; 32:322-346. [PMID: 33595986 PMCID: PMC8815414 DOI: 10.1097/jnc.0000000000000240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT People living with HIV are living longer, high-quality lives; however, as they age, this population is at increased risk for developing chronic comorbidities, including cardiovascular disease, certain types of cancer (e.g., lung, anal, and liver), and diabetes mellitus. The purpose of this state-of-the-science review is to provide an evidence-based summary on common physical comorbidities experienced by people living and aging with HIV. We focus on those chronic conditions that are prevalent and growing and share behavioral risk factors that are common in people living with HIV. We will discuss the current evidence on the epidemiology, physiology, prevention strategies, screening, and treatment options for people living with HIV across resource settings.
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Affiliation(s)
- Allison R Webel
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie Schexnayder
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Patricia A Cioe
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie A Zuñiga
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
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6
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Diaz NA, Ambrosioni J, Tuset M, Brunet M, Cofan F, Crespo G, Ruiz P, Redondo-Pachón D, Crespo M, Marín-Casino M, Moreno A, Miró JM. Tacrolimus, Sirolimus and Everolimus Doses in HIV-Infected Solid-Organ Recipients, Requiring a Cobicistat-Based Antiretroviral Regimen: Report of Three Cases and Review. Infect Dis Ther 2021; 10:1055-1064. [PMID: 33830489 PMCID: PMC8027707 DOI: 10.1007/s40121-021-00430-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/02/2021] [Indexed: 12/22/2022] Open
Abstract
People living with HIV should be considered candidates for solid-organ transplantation (SOT). However, managing HIV-infected patients undergoing SOT represents a major challenge due to the potential drug-drug interactions between antiretroviral drugs and immunosuppressive agents, particularly when resorting to antiretroviral drugs that require pharmacokinetic enhancers. We report three cases of cobicistat-tacrolimus co-administration, two of which also include the co-administration of mTOR inhibitors, in HIV-positive patients undergoing SOT (2 kidney and 1 liver recipient). We review previously reported cases and provide recommendations for initial management following transplantation.
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Affiliation(s)
- Natalia A Diaz
- Infectious Diseases Service, Hospital Cuenca Alta, Cañuelas, Argentina.,HIV Unit and Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- HIV Unit and Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
| | | | - Mercé Brunet
- Pharmacology and Toxicology, SBGM, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Frederic Cofan
- Nephrology Service, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Gonzalo Crespo
- Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Pablo Ruiz
- Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Dolores Redondo-Pachón
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research-REDINREN, Barcelona, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research-REDINREN, Barcelona, Spain
| | | | - Asunción Moreno
- HIV Unit and Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José M Miró
- HIV Unit and Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
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7
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Morales MK, Lambing T, Husson J. Review: Evaluation and Management of the HIV/HCV Co-Infected Kidney or Liver Transplant Candidate. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Tourret J, Guiguet M, Lassalle M, Grabar S, Lièvre L, Isnard-Bagnis C, Barrou B, Costagliola D, Couchoud C, Abgrall S, Tézenas Du Montcel S. Access to the waiting list and to kidney transplantation for people living with HIV: A national registry study. Am J Transplant 2019; 19:3345-3355. [PMID: 31206243 DOI: 10.1111/ajt.15500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 01/25/2023]
Abstract
We compared access to a kidney transplantation (KT) waiting list (WL) and to KT between people living with HIV (PLHIV) and HIV-uninfected controls. Using the REIN (the national Renal Epidemiology and Information Network registry), we included all PLHIV initiating dialysis in France throughout 2006-2010 and HIV-uninfected controls matched for age, sex, year of dialysis initiation, and the existence of a diabetic nephropathy. Patients were prospectively followed until December 2015. We used a competitive risk approach to assess the cumulative incidence of enrollment on WL and of KT, with death as a competing event (subdistribution hazard ratio adjusted on comorbidities, asdHR). There were 255 PLHIV in the REIN (median age 47 years) of whom 180 (71%) were also found in the French Hospital Database on HIV (FHDH-ANRS CO4) including 126 (70%) known to be on antiretroviral therapy with HIV viral suppression (VS). Five years after dialysis initiation, 65%, and 76%, of treated PLHIV with VS, and of HIV-uninfected controls were enrolled on a WL (asdHR 0.68; 95% CI 0.50-0.91). Access to KT was also less frequent and delayed for treated PLHIV with VS (asdHR 0.75, 95% CI, 0.52-1.10). PLHIV continue to face difficulties to access KT.
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Affiliation(s)
- Jérôme Tourret
- Sorbonne Université, Paris, France.,INSERM UMR1138, Paris, France.,Assistance Publique-Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Département d'urologie, néphrologie et transplantation, Paris, France
| | - Marguerite Guiguet
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France
| | - Mathilde Lassalle
- REIN registry, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Sophie Grabar
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Assistance Publique-Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Cochin Broca Hôtel-Dieu, Unité de Biostatistique et d'épidémiologie, Paris, France
| | - Laurence Lièvre
- REIN registry, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Corinne Isnard-Bagnis
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Département d'urologie, néphrologie et transplantation, Paris, France
| | - Benoit Barrou
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Département d'urologie, néphrologie et transplantation, Paris, France
| | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France
| | - Cécile Couchoud
- REIN registry, Agence de la biomédecine, Saint Denis La Plaine, France.,Université Claude Bernard Lyon I, Lyon, France.,UMR CNRS 5558, Laboratoire de Biostatistique en Santé, Lyon, France
| | - Sophie Abgrall
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France.,Université Paris-Saclay, Univ. Paris Sud, Paris, France.,UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France.,Assistance Publique-Hôpitaux de Paris AP-HP, Hôpital Antoine Béclère, Service de Médecine interne, Clamart, France
| | - Sophie Tézenas Du Montcel
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, Paris, France.,Assistance Publique-Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
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9
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Zheng X, Gong L, Xue W, Zeng S, Xu Y, Zhang Y, Hu X. Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis. AIDS Res Ther 2019; 16:37. [PMID: 31747972 PMCID: PMC6868853 DOI: 10.1186/s12981-019-0253-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/09/2019] [Indexed: 01/01/2023] Open
Abstract
Background Kidney transplantation is now a viable alternative to dialysis in HIV-positive patients who achieve good immunovirological control with the currently available antiretroviral therapy regimens. This systematic review and meta-analysis investigate the published evidence of outcome and risk of kidney transplantation in HIV-positive patients following the PRISMA guidelines. Methods Searches of PubMed, the Cochrane Library and EMBASE identified 27 cohort studies and 1670 case series evaluating the survival of HIV-positive kidney transplant patients published between July 2003 and May 2018. The regimens for induction, maintenance therapy and highly active antiretroviral therapy, acute rejection, patient and graft survival, CD4 count and infectious complications were recorded. We evaluated the patient survival and graft survival at 1 and 3 years respectively, acute rejection rate and also other infectious complications by using a random-effects analysis. Results At 1 year, patient survival was 0.97 (95% CI 0.95; 0.98), graft survival was 0.91 (95% CI 0.88; 0.94), acute rejection was 0.33 (95% CI 0.28; 0.38), and infectious complications was 0.41 (95% CI 0.34; 0.50), and at 3 years, patient survival was 0.94 (95% CI 0.90; 0.97) and graft survival was 0.81 (95% CI 0.74; 0.87). Conclusions With careful selection and evaluation, kidney transplantation can be performed with good outcomes in HIV-positive patients.
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10
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Hwang HP, Yu HC, Kang KP, Kim W, Park SK, Ku JS, Kim H, Lee S. Kidney transplantation in human immunodeficiency virus-infected patients: a report of two cases and a review of the literatures. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:60-64. [PMID: 35769407 PMCID: PMC9186908 DOI: 10.4285/jkstn.2019.33.3.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/04/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection was traditionally considered an absolute contraindication for transplantation because of concerns about HIV disease progression due to immunosuppression. Since potent antiretroviral therapies (ARTs) have become widely available, the prognosis of HIV-infected kidney transplant recipients has dramatically improved. Recent results of prospective multicenter trials on kidney transplantation (KT) in HIV-positive candidates have demonstrated the success and challenges of transplantation in this population. Several studies have reported comparable patient and graft outcomes between HIV-infected and HIV-uninfected recipients after KT in the era of potent combined ARTs. We report two cases of HIV-infected patients who underwent KT at our hospital. In this paper, we present a detailed report of two cases and provide a short review of the existing literature.
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Affiliation(s)
- Hong Pil Hwang
- Department of General Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Hee Chul Yu
- Department of General Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyung Pyo Kang
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Won Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Sung Kwang Park
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Jeong Sang Ku
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Hyeongwan Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
| | - Sik Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National Universi
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11
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Alameddine M, Jue JS, Zheng I, Ciancio G. Challenges of kidney transplantation in HIV positive recipients. Transl Androl Urol 2019; 8:148-154. [PMID: 31080775 DOI: 10.21037/tau.2018.11.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection has long been a contraindication to kidney transplantation due to transplant immunosuppression, HIV-associated renal dysfunction, and nephrotoxicity associated with antiretroviral therapy (ART). However, advances in antiretroviral therapies and transplant immunosuppression regimens have allowed patients to successfully undergo kidney transplantation. Emerging data has shown that kidney transplantation may be a viable option for appropriately selected HIV patients with end-stage renal disease (ESRD). In this review, we discuss the indications, immunosuppression protocols, and outcomes of kidney transplantation in HIV patients.
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Affiliation(s)
- Mahmoud Alameddine
- Department of Surgery and Urology, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Joshua S Jue
- Urology Department, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Ian Zheng
- Department of Surgery and Urology, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery and Urology, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
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12
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Bayraktar A, Dirim AB, Bakkaloglu H, Kaan Gok AF, Demir E, Ucar AR, Turkmen A, Aydin AE. Deceased Donor Kidney Transplantation in a Human Immunodeficiency Virus-Infected Recipient: A Case Report. Transplant Proc 2019; 51:1187-1189. [PMID: 31101197 DOI: 10.1016/j.transproceed.2019.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
Abstract
Human immunodeficiency virus (HIV) infection has traditionally been considered an absolute contraindication for transplantation because immunosuppression will accelerate the disease progression and increase mortality. New antiretroviral agents have given rise to new perspectives and transplantation practices. Now renal transplantation is the gold standard treatment for end-stage renal disease in HIV-infected patients, but increased rejection and toxicity rates and compliance with treatment are important issues. Therefore, patient selection and follow-up should be done carefully in this patient group. Here we present a 51-year-old, male, HIV-infected patient who was diagnosed with HIV at his routine serologic investigation at 2015. Highly active antiretroviral therapy was initiated. One haplotype-matched kidney transplantation from a deceased donor was performed on October 19, 2016. Induction therapy was not administered, and the immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisolone. After 26 months, serum creatinine was 1.1 mg/dL and proteinuria 0.1 g/day. There was no development of donor-specific antibodies. The patient's current HIV viral load remains undetectable (and had been the entire time post-transplantation) while his CD4+ T-cell count currently is 543/mm3.
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Affiliation(s)
- A Bayraktar
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A B Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - H Bakkaloglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A F Kaan Gok
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - E Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - A R Ucar
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A E Aydin
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Sparkes T, Manitpisitkul W, Masters B, Bartlett ST, Davis C, Husson J, Amoroso A, Haririan A. Impact of antiretroviral regimen on renal transplant outcomes in HIV-infected recipients. Transpl Infect Dis 2018; 20:e12992. [PMID: 30184310 DOI: 10.1111/tid.12992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/05/2018] [Accepted: 08/17/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Protease inhibitors (PI) pose a challenge post-transplant due to significant drug interactions with calcineurin inhibitors, prompting many clinicians to convert patients to non-interacting regimens prior to transplant. The purpose of this study was to examine the impact of PI-based regimens on graft outcomes in HIV-infected renal transplant recipients. METHODS In this retrospective cohort study, 50 HIV-infected renal allograft recipients (27 receiving a PI regimen, 23 receiving a non-PI regimen) transplanted between 2003-2015 were analyzed. RESULTS Cumulative rejection rates at 12 and 36 months were 41% and 54% in the PI group vs 52% and 86% in the non-PI group. At last follow-up, the overall risk of acute rejection in the PI group was 46% lower compared with the non-PI cohort (P = 0.12). Patients who received a PI-based regimen had significantly reduced graft failure rates (P = 0.027). There was no difference between groups in the degree of interstitial fibrosis/tubular atrophy, arteriolar hyalinosis, arterial sclerosis, or glomerular sclerosis on available biopsies, despite longer follow-up time in the PI group. CONCLUSIONS Our study suggests that PI-based antiretroviral therapy regimens are associated with improved graft survival and that patients can achieve adequate outcomes on a PI-based regimen when necessary. Due to study limitations, further studies are needed to determine the optimal immunosuppression/antiretroviral therapy regimen post-transplant.
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Affiliation(s)
- Tracy Sparkes
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland
| | - Wana Manitpisitkul
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland
| | - Brian Masters
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland
| | - Stephen T Bartlett
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles Davis
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer Husson
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anthony Amoroso
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Abdolreza Haririan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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15
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Effectiveness of kidney transplantation in HIV-infected recipients under combination antiretroviral therapy: a single-cohort experience (Brescia, Northern Italy). Infection 2017; 46:77-82. [PMID: 29103079 DOI: 10.1007/s15010-017-1092-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 10/25/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Kidney transplantation was recently introduced for the treatment of end stage renal disease (ESRD) in HIV-infected patients. We report the results of the first 28 procedures at our centre. METHODS A retrospective study was conducted on HIV-infected patients evaluated for kidney transplantation between January 2005 and October 2016. Patients were selected and monitored by the kidney transplantation and infectious diseases teams, according to the national protocol. RESULTS 60 patients were evaluated; 32 entered the list and 28 were transplanted. Median CD4+ count was 337 cell/μL at transplantation and 399 cell/μL 12 months thereafter. HIV RNA was undetectable at transplantation in 27/28 patients and became undetectable within 24 weeks in the only patient starting antiretroviral combination therapy (cART) after surgery. Four patients experienced virological failure, but reached again undetectability after cART regimen change. At last available point of follow-up (median 126.1 weeks), HIV RNA was undetectable in all patients. Three patients experienced AIDS-defining events. We observed a cumulative number of 19 acute rejections in 16 patients (median time from transplantation to first rejection 5.2 weeks). Survival rate was 82.1%. To avoid pharmacokinetics (PK) interactions, cART regimen was changed from a protease inhibitor (PI)/non-nucleoside reverse transcriptase inhibitor (NNRTI)-based to an integrase inhibitor (InSTI)-based regimen in 11/20 alive patients with functioning graft. CONCLUSIONS Kidney transplantation appears to be safe in HIV-infected patients carefully selected. As previously reported, we observed a high incidence of acute rejection. We expect that the recent implementation of the immunosuppressive protocols will allow a better immunologic control. Moreover, the introduction of InSTI permits a better strategy of cART, with lower incidence of PK interactions with immunosuppressive drugs.
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HIV Infection in the Native and Allograft Kidney: Implications for Management, Diagnosis, and Transplantation. Transplantation 2017; 101:2003-2008. [PMID: 28196049 DOI: 10.1097/tp.0000000000001674] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The native kidney is a reservoir for human immunodeficiency virus (HIV)-1 and a site of viral replication, similar to lymphoid tissue, gut-associated lymphoid tissue or semen. The ability of the virus to persist may result from either a true latency or sequestration in an anatomic site that is not effectively exposed to antiretroviral therapy. The presence of HIV in kidney epithelial cells will lead progressively to end-stage renal disease. For decades, HIV-infected patients were excluded from consideration for kidney transplantation. Hemodialysis and peritoneal dialysis were the only forms of treatment available to these patients. The introduction of combined antiretroviral therapy has changed the overall prognosis of these patients and allowed them to benefit from kidney transplantation without an increased risk of opportunistic infections or cancer. However, we recently established that HIV-1 can infect kidney transplant epithelial cells in the absence of detectable viremia. The presence of HIV in kidney cells can manifest itself in multiple ways, ranging from indolent nephropathy and inflammation to proteinuria with glomerular abnormalities. Because the tools that are available to diagnose the presence of HIV in kidney cells are complex, the rate of infection is certainly underestimated. This finding will certainly have implications in the management of patients, particularly for HIV-positive donors. The purpose of this review is to highlight recent evidence that the allograft kidney can be infected by the virus after transplantation as well as the associated consequences.
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Chazot R, Botelho-Nevers E, Frésard A, Maillard N, Mariat C, Lucht F, Gagneux-Brunon A. Diagnostic challenges of kidney diseases in HIV-infected patients. Expert Rev Anti Infect Ther 2017; 15:903-915. [PMID: 28898114 DOI: 10.1080/14787210.2017.1379395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a prevalent comorbidity in persons living with HIV infection (PLWH) associated with an increase in cardiovascular morbidity and all-cause mortality. Furthermore, early diagnosis of CKD is difficult in PLWH. Areas covered: We reviewed the main diagnostic tools for CKD in PLWH, and discussed their strengths and limits. We performed a literature search on PubMed to identify reviews and clinical trials dealing with attractive kidney biomarkers of CKD in PLWH, with the following key words: 'HIV AND kidney', 'HIV AND Kidney biomarkers', 'CKD AND Kidney biomarkers'. Expert commentary: Currently, CKD diagnosis is based on the estimation of Glomerular Filtration Rate (GFR), and measurement of proteinuria by urine protein/creatinine ratio (uPCR). These parameters are independent and complementary predictors of outcomes. GFR estimates are lacking in accuracy in PLWH. The best GFR estimate is CKD-EPI study equation. Moreover, low-grade proteinuria is associated with an increased risk of kidney disease progression in PLWH, and guidelines derived from the general population may lack sensitivity. Different biomarkers of kidney diseases like N-acetyl beta glucosaminidase (NAG), Kidney Injury Molecule-1 (KIM-1), and Alpha-1-microglobulin may predict kidney disease progression and mortality in PLWH. Others may help clinicians detect antiretroviral-induced tubulopathy, or predict cardiovascular events. More studies are needed to validate the routine use of these types of biomarkers.
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Affiliation(s)
- Robin Chazot
- a Department of Nephrology, Dialysis, Transplantation and Hypertension , University Hospital of Saint-Étienne , Saint-Étienne , France
| | - Elisabeth Botelho-Nevers
- b Department of Infectious and Tropical Diseases , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Anne Frésard
- b Department of Infectious and Tropical Diseases , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Nicolas Maillard
- a Department of Nephrology, Dialysis, Transplantation and Hypertension , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Christophe Mariat
- a Department of Nephrology, Dialysis, Transplantation and Hypertension , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Frédéric Lucht
- b Department of Infectious and Tropical Diseases , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Amandine Gagneux-Brunon
- b Department of Infectious and Tropical Diseases , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
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Cristelli MP, Cofán F, Tedesco-Silva H, Trullàs JC, Santos DWCL, Manzardo C, Agüero F, Moreno A, Oppenheimer F, Diekmann F, Medina-Pestana JO, Miro JM. Regional differences in the management and outcome of kidney transplantation in patients with human immunodeficiency virus infection: A 3-year retrospective cohort study. Transpl Infect Dis 2017; 19. [PMID: 28508573 DOI: 10.1111/tid.12724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/06/2017] [Accepted: 03/05/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the developed world, kidney transplantation (KT) in patients with human immunodeficiency virus (HIV) infection is well established. Developing countries concentrate 90% of the people living with HIV, but their experience is underreported. Regional differences may affect outcomes. OBJECTIVES We compared the 3-year outcomes of patients with HIV infection receiving a KT in two different countries, in terms of incomes and development. METHODS This was an observational, retrospective, double-center study, including all HIV-infected patients >18 years old undergoing KT. RESULTS Between 2005 and 2015, 54 KTs were performed (39 in a Brazilian center, and 15 in a Spanish center). Brazilians had less hepatitis C virus co-infection (5% vs 27%, P=.024). Median cold ischemia time was higher in Brazil (25 vs 18 hours, P=.001). Biopsy-proven acute rejection (AR) was higher in Brazil (33% vs 13%, P=.187), as were the number of AR episodes (22 vs 4, P=.063). Patient survival at 3 years was 91.3% in Brazil and 100% in Spain; P=.663. All three cases of death in Brazil were a result of bacterial infections within the first year post transplant. At 3 years, survival free from immunosuppressive changes was lower in Brazil (56% vs 90.9%, P=.036). Raltegravir-based treatment to avoid interaction with calcineurin inhibitor was more prevalent in Spain (80% vs 3%; P<.001). HIV infection remained under control in all patients, with undetectable viral load and no opportunistic infections. CONCLUSION Important regional differences exist in the demographics and management of immunosuppression and antiretroviral therapy. These details may influence AR and infectious complications. Non-AIDS infections leading to early mortality in Brazil deserve special attention.
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Affiliation(s)
| | - Federico Cofán
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Joan Carles Trullàs
- Hospital d'Olot, Medical Science Department, University of Girona, Girona, Spain
| | | | | | - Fernando Agüero
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Fritz Diekmann
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Jose Maria Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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An Exception to the Rule or a Rule for the Exception? The Potential of Using HIV-Positive Donors in Canada. Transplantation 2017; 101:671-674. [PMID: 28323771 DOI: 10.1097/tp.0000000000001630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Selected human immunodeficiency virus (HIV)-infected patients with end organ failure can safely receive an organ transplant from an HIV uninfected donor. Recent demonstration of the short term safety of organ transplantation between HIV-infected persons prompted a change in US American law to allow such transplantations. Prompted by the recent completion of the first organ transplantation between HIV-infected persons in Canada, we review Canadian law regarding the use of organs from HIV-infected donors, estimate the number of potential HIV-infected donors in Canada, and critically review considerations related to advancing organ transplantation from HIV-infected donors in Canada. Existing legislation allows organ transplantation from an HIV-infected donor under exceptional medical circumstances and therefore no change in legislation is required to increase utilization of organs from HIV-infected donors for transplantation in Canada. Among 335,793 hospital deaths between 2005 and 2009 in Canadian provinces excluding Quebec, 39 potential HIV-infected donors were identified. The actual number of HIV potential donors is estimated to be approximately 60% lower (3-5 potential donor per year), if the absence of viremia is required for transplantation. Although offering all Canadians the opportunity to donate organs is a laudable goal, further research to understand the need for HIV-positive donors and the willingness of HIV-positive recipients to accept organs from HIV-positive donors is needed to inform future policy regarding organ donation from HIV-infected persons in Canada.
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20
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Vicari AR, Spuldaro F, Sandes-Freitas TV, Cristelli MP, Requião-Moura LR, Reusing JO, Pierrotti LC, Oliveira ML, Girão CM, Gadonski G, Kroth LV, Deboni LM, Ferreira GF, Tedesco-Silva H, Esmeraldo R, David-Neto E, Saitovitch D, Keitel E, Garcia VD, Pacheco-Silva A, Medina-Pestana JO, Manfro RC. Renal transplantation in human immunodeficiency virus-infected recipients: a case-control study from the Brazilian experience. Transpl Infect Dis 2016; 18:730-740. [PMID: 27503081 DOI: 10.1111/tid.12592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/27/2016] [Accepted: 06/24/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy has turned human immunodeficiency virus (HIV)-infected patients with end-stage renal disease into suitable candidates for renal transplantation. We present the Brazilian experience with kidney transplantation in HIV-infected recipients observed in a multicenter study. METHODS HIV-infected kidney transplant recipients and matched controls were evaluated for the incidence of delayed graft function (DGF), acute rejection (AR), infections, graft function, and survival of patients and renal grafts. RESULTS Fifty-three HIV-infected recipients and 106 controls were enrolled. Baseline characteristics were similar, but a higher frequency of pre-transplant positivity for hepatitis C virus and cytomegalovirus infections was found in the HIV group. Immunosuppressive regimens did not differ, but a trend was observed toward lower use of anti-thymocyte globulin in the group of HIV-infected recipients (P = 0.079). The HIV-positive recipient group presented a higher incidence of treated AR (P = 0.036) and DGF (P = 0.044). Chronic Kidney Disease Epidemiology Collaboration estimated that glomerular filtration rate was similar at 6 months (P = 0.374) and at 12 months (P = 0.957). The median number of infections per patient was higher in the HIV-infected group (P = 0.018). The 1-year patient survival (P < 0.001) and graft survival (P = 0.004) were lower, but acceptable, in the group of HIV-infected patients. CONCLUSIONS In the Brazilian experience, despite somewhat inferior outcomes, kidney transplantation is an adequate therapy for selected HIV-infected recipients.
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Affiliation(s)
- A R Vicari
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - F Spuldaro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - M P Cristelli
- Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil
| | - L R Requião-Moura
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - J O Reusing
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - L C Pierrotti
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - M L Oliveira
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - C M Girão
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - G Gadonski
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L V Kroth
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L M Deboni
- Hospital Municipal São José e Fundação Pró-Rim, Joinville, SC, Brazil
| | - G F Ferreira
- Hospital Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - H Tedesco-Silva
- Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil
| | - R Esmeraldo
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - E David-Neto
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - D Saitovitch
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - E Keitel
- Renal Transplant Unit, Hospital Santa Casa de Porto Alegre, Federal University of Medical Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - V D Garcia
- Renal Transplant Unit, Hospital Santa Casa de Porto Alegre, Federal University of Medical Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - A Pacheco-Silva
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - R C Manfro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Abstract
Infections and malignancies are the expected complications of immunosuppressive therapy, which non-specifically impairs cellular and humoral immune responses in renal transplant recipients. Infections were usually frequent and severe during the early post-transplant period (first year). Recent diagnostic methods (molecular biology) and availability of new antivirals, antifungal and antibiotic drugs made rapid diagnosis and systematic preventive strategies much easier and this resulted in a significant reduction of infections and infectious death in this population. However, new infectious agents like BK polyomavirus, hepatitis E virus, parvovirus (as well as Chigunkunya, West Nile and others in particular areas) were recently recognized as responsible of aggressive infections in the immunocompromised host. Malignancies are also common after transplantation, due to the intensity and duration of immunosuppression. Skin cancers and lymphoproliferative disorders are the most common and are undoubtedly caused by viral infections, but incidence of non-skin cancers is also increased. After reduction of immunosuppression, treatment is similar to non-transplant patients: Results are usually poor and cancer is now the third cause of death in transplant recipients. Due to their anti-proliferative and anti-tumoral properties, incidence of de novo cancer significantly decreased in patients receiving mTor inhibitors as maintenance immunosuppression; furthermore, in patients already diagnosed with Kaposi sarcoma or recurrent skin cancers, introduction of mTor was associated with stabilisation and/or regression of malignant lesions.
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Azar MM, Malinis MF, Moss J, Formica RN, Villanueva MS. Integrase strand transferase inhibitors: the preferred antiretroviral regimen in HIV-positive renal transplantation. Int J STD AIDS 2016; 28:447-458. [PMID: 27193421 DOI: 10.1177/0956462416651528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the era of antiretroviral therapy, people living with HIV/AIDS live longer and are subject to co-morbidities that affect the general population, such as chronic kidney disease. An increasing number of people living with HIV/AIDS with end-stage renal disease are candidates for renal transplantation. Prior experience demonstrated that HIV-positive renal transplant recipients had acceptable survival but graft survival was decreased and rejection rates were increased, possibly due to suboptimal management of immunosuppressive medications in the face of drug interactions with antiretroviral therapy, particularly protease inhibitors and non-nucleoside reverse transcriptase inhibitors. Integrase strand transferase inhibitors are advantageous since they avoid drug-drug interactions with immunosuppressive drugs such as calcineurin inhibitors. We report clinical outcomes of 12 HIV-positive patients who underwent 13 kidney transplantations at our institution between 2000 and 2015. Cumulative survival was 75%, one-year and three-year survival were 100% and 63%. Integrase strand transferase inhibitor-based regimens were used in nine patients, of which eight survived. In patients on integrase strand transferase inhibitor, there was 100% graft survival and two had allograft rejection. In contrast, graft failure occurred in three patients on non-integrase strand transferase inhibitor-based regimens. Based on our study findings and on previously published data, we conclude that integrase strand transferase inhibitor-based therapy, preferably instituted prior to transplantation, is the preferred antiretroviral regimen in HIV-positive renal transplantation.
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Affiliation(s)
- Marwan M Azar
- 1 Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Maricar F Malinis
- 1 Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.,2 Department of Surgery, Section of Transplantation and Immunology, Yale School of Medicine, New Haven, CT, USA
| | - J Moss
- 3 Department of Internal Medicine, Chelsea Healthcare Center, Harvard Medical School, Boston, MA, USA
| | - Richard N Formica
- 2 Department of Surgery, Section of Transplantation and Immunology, Yale School of Medicine, New Haven, CT, USA.,4 Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | - Merceditas S Villanueva
- 1 Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
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Nashar K, Sureshkumar KK. Update on kidney transplantation in human immunodeficiency virus infected recipients. World J Nephrol 2016; 5:300-307. [PMID: 27458559 PMCID: PMC4936337 DOI: 10.5527/wjn.v5.i4.300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/10/2016] [Accepted: 05/09/2016] [Indexed: 02/06/2023] Open
Abstract
Improved survival of human immunodeficiency virus (HIV) infected patients with chronic kidney disease following the introduction of antiretroviral therapy resulted in the need to revisit the topic of kidney transplantation in these patients. Large cohort studies have demonstrated favorable outcomes and proved that transplantation is a viable therapeutic option. However, HIV-infected recipients had higher rates of rejection. Immunosuppressive therapy did not negatively impact the course of HIV infection. Some of the immunosuppressive drugs used following transplantation exhibit antiretroviral effects. A close collaboration between infectious disease specialists and transplant professionals is mandatory in order to optimize transplantation outcomes in these patients. Transplantation from HIV+ donors to HIV+ recipients has been a subject of intense debate. The HIV Organ Policy Equity act provided a platform to research this area further and to develop guidelines. The first HIV+ to HIV+ kidney transplant in the United States and the first HIV+ to HIV+ liver transplant in the world were recently performed at the Johns Hopkins University Medical Center.
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Mittal S, Choudhary P, Callaghan C, Hilton R, Drage M. First case of pancreas transplant alone in a patient with diabetes and HIV infection. Int J STD AIDS 2016; 27:1350-1353. [PMID: 27099169 DOI: 10.1177/0956462416645996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
Abstract
Chronic conditions have largely replaced opportunistic infections as the leading causes of mortality in human immunodeficiency virus (HIV) infection. Pancreas transplantation alone can be performed for people with difficult to manage diabetes associated with severe hypoglycaemic unawareness. For carefully selected patients, pancreas transplantation alone has the potential to dramatically improve quality and quantity of life. Historically, HIV was considered a contraindication to transplantation; however, today renal transplantation for people with end-stage kidney disease and HIV infection is increasingly common. We describe the use of a standard immunosuppression regimen in combination with effective antiretroviral control using a stable highly active antiretroviral therapy regimen with minimal interaction with immunosuppressants. We describe what is, to our knowledge, the first case of pancreas transplantation alone performed for this particularly challenging group, resulting in complete resolution of hypoglycaemic symptoms. We suggest that this group of patients should receive optimal diabetes management, including access to transplantation where appropriate, and demonstrate that pancreas transplantation alone is feasible for people with HIV infection.
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Affiliation(s)
- Shruti Mittal
- Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK
| | - Pratik Choudhary
- Department of Diabetic Medicine, Kings College Hospital, London, UK
| | - Chris Callaghan
- Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK
| | - Rachel Hilton
- Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK
| | - Martin Drage
- Department of Renal Transplantation, Directorate of Abdominal Medicine and Surgery, Guy's Hospital, London, UK
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Impact of Tacrolimus Compared With Cyclosporin on the Incidence of Acute Allograft Rejection in Human Immunodeficiency Virus–Positive Kidney Transplant Recipients. Transplantation 2016; 100:871-8. [DOI: 10.1097/tp.0000000000000879] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Facial transplantation: worth the risks? A look at evolution of indications over the last decade. Curr Opin Organ Transplant 2016; 20:615-20. [PMID: 26536422 DOI: 10.1097/mot.0000000000000253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The first face transplant was performed 10 years ago by Dubernard and his team in France. Since then, surgeons have continued to push the frontiers of vascularized composite allotransplantation and broaden the indications for face transplantation. In this review, we summarize some of the recent successes and failures in facial transplantation from the point of view of indications. RECENT FINDINGS Recent literature includes case reports on face transplants in sensitized patient, with simultaneous bilateral upper extremity transplants, positive HIV status, and postmalignancy. Additionally, we summarize some of the outcomes of face transplants, including chronic rejection and latent viral infections. SUMMARY Facial injuries vary widely, thus candidacy for face transplant should be assessed based on current guidelines, and a case-by-case basis. Although sensitization to donor-specific antigens should not be an absolute contraindication for facial allotransplantation, along with other comorbidities such as positive HIV status, history of malignancy should be evaluated cautiously. Additionally, multiple case studies advice against simultaneous transplantation of multiple vascularized composite allotransplantations. Other considerations include psychological health, social support, and availability for long-term follow-up. Ultimately, face transplant is not simply a surgery; it is a lifelong commitment between a patient and his/her medical team.
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Nunes AT, Pereira L, Cerqueira A, Bustorff M, Sampaio S, Ferreira I, Tavares I, Santos J, Pestana M. Renal transplantation in human immunodeficiency virus-positive patients: a report of four cases. Transplant Proc 2015; 46:1718-22. [PMID: 25131020 DOI: 10.1016/j.transproceed.2014.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Renal transplantation (RT) in patients infected with human immunodeficiency virus (HIV) has significantly improved under the advent of combined antiretroviral therapy (cART). The authors describe their experience in RT in patients with HIV from September 2010 to June 2013. CASES REPORT Four patients underwent transplantation (3 with HIV-1 and 1 with HIV-2), three patients were male, and one was black. None were coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV). Etiology of kidney disease was HIV-associated nephropathy (2 patients), immunoglobulin (Ig)A nephropathy, and unknown. Average age at RT was 51 (range, 41-63) years. No patient was of high immunologic risk. Immunosuppression consisted of basiliximab for induction and prednisolone, tacrolimus (TAC), and mycophenolate mofetil for maintenance. TAC levels varied considerably in the early days (8.5-46 ng/mL), requiring major adjustments in TAC dose. Only the HIV-2 patient had delayed graft function. The follow-up of patients with HIV-1 was 37, 19, and 16 months, and 3 months for the HIV-2 patient. CD4+ T cells decreased in the early days after transplantation with subsequent improvement, along with persistent virological suppression. In the HIV-1 group there were no major infectious, cardiovascular, or neoplastic complications. Nevertheless, the HIV-2 patient died 3 months after RT due to H1N1 pneumonia complicated by pulmonary aspergillosis. Average estimated (CKD- EPI) glomerular filtration rate (eGFR) at 6 months was 85.6 mL/min/1.73 m(2). CONCLUSION Besides the difficulty in adjusting calcineurin inhibitors levels due to its interaction with antiretroviral therapy, namely with protease inhibitors, no patient had acute rejection. Furthermore, all patients presented an excellent control of viro-immunologic parameters. At the last follow-up neither cardiovascular events nor neoplastic complications were observed. Our results highlight the favorable outcome of RT in HIV-1-infected patients. The HIV-2 patient died due to severe infection, and the clinical management and potential benefit of RT in HIV-2-infected patients needs further study.
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Affiliation(s)
- A T Nunes
- Nephrology Department, Hospital São João, Oporto, Portugal.
| | - L Pereira
- Nephrology Department, Hospital São João, Oporto, Portugal
| | - A Cerqueira
- Nephrology Department, Hospital São João, Oporto, Portugal
| | - M Bustorff
- Nephrology Department, Hospital São João, Oporto, Portugal
| | - S Sampaio
- Nephrology Department, Hospital São João, Oporto, Portugal
| | - I Ferreira
- Nephrology Department, Hospital São João, Oporto, Portugal
| | - I Tavares
- Nephrology Department, Hospital São João, Oporto, Portugal
| | - J Santos
- Nephrology Department, Hospital São João, Oporto, Portugal
| | - M Pestana
- Nephrology Department, Hospital São João, Oporto, Portugal
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Wright AJ, Gill JS. Kidney Transplantation in HIV-Infected Recipients: Encouraging Outcomes, but Registry Data Are No Longer Enough. J Am Soc Nephrol 2015; 26:2070-1. [PMID: 25791726 PMCID: PMC4552126 DOI: 10.1681/asn.2015010059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - John S Gill
- Division of Nephrology, and Center for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada; and Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts
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Manzardo C, Tuset M, Miró JM, Gatell JM. Interacciones graves o potencialmente letales entre antirretrovirales y otros medicamentos. Enferm Infecc Microbiol Clin 2015; 33:e15-30. [DOI: 10.1016/j.eimc.2014.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/12/2014] [Accepted: 02/23/2014] [Indexed: 12/31/2022]
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McCulloch MI, Kala UK. Renal transplantation in human immunodeficiency virus (HIV)-positive children. Pediatr Nephrol 2015; 30:541-8. [PMID: 24691821 DOI: 10.1007/s00467-014-2782-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 02/03/2014] [Accepted: 02/04/2014] [Indexed: 11/26/2022]
Abstract
Renal transplantation is being performed in adult human immunodeficiency virus (HIV)-positive patients and increasingly in paediatric patients as well. A multidisciplinary team involving an infectious disease professional is required to assist with HIV viral-load monitoring and in choosing the most appropriate highly active antiretroviral therapy (HAART). Drug interactions complicate immunosuppressant therapy and require careful management. The acute rejection rates appear to be similar in adults to those in noninfective transplant recipients. Induction with basiliximab and calcineurin-based immunosuppression appears to be safe and effective in these recipients. Prophylaxis is advised for a variety of infections and may need life-long administration, especially in children. Organ shortage remains a significant problem, and kidneys from deceased HIV-positive donors have been used successfully in a small study population. Overall, with careful planning and close follow-up, successful renal transplantation for paediatric HIV-infected recipients is possible.
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Affiliation(s)
- Mignon I McCulloch
- Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa,
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31
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End-stage kidney disease and kidney transplantation in HIV-positive patients: an observational cohort study. J Acquir Immune Defic Syndr 2015; 67:177-80. [PMID: 25072607 DOI: 10.1097/qai.0000000000000291] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
End-stage kidney disease (ESKD) is a major complication of HIV infection. We observed a 3.8-fold increase in ESKD prevalence among black patients in the UK CHIC cohort during the 12-year study period. As of 2005, 107 patients had an ESKD diagnosis, 69 of whom (64%) were considered suitable for kidney transplantation (KT) and 34 (32%) had received a KT. Survival was similar for KT recipients and those awaiting KT (85% and 89% at 5 years, respectively; P = 0.53). Our results endorse the use of KT to manage ESKD in HIV-positive patients.
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Lucas GM, Ross MJ, Stock PG, Shlipak MG, Wyatt CM, Gupta SK, Atta MG, Wools-Kaloustian KK, Pham PA, Bruggeman LA, Lennox JL, Ray PE, Kalayjian RC. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e96-138. [PMID: 25234519 PMCID: PMC4271038 DOI: 10.1093/cid/ciu617] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/25/2014] [Indexed: 12/15/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Paul A. Pham
- Johns HopkinsSchool of Medicine, Baltimore, Maryland
| | - Leslie A. Bruggeman
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Robert C. Kalayjian
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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Miro J, Agüero F, Duclos-Vallée JC, Mueller N, Grossi P, Moreno A. Infections in solid organ transplant HIV-infected patients. Clin Microbiol Infect 2014; 20 Suppl 7:119-30. [DOI: 10.1111/1469-0691.12754] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Immunosuppression regimen and the risk of acute rejection in HIV-infected kidney transplant recipients. Transplantation 2014; 97:446-50. [PMID: 24162248 DOI: 10.1097/01.tp.0000436905.54640.8c] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Kidney transplantation (KT) is the treatment for end-stage renal disease in appropriate HIV-positive individuals. However, acute rejection (AR) rates are over twice those of HIV-negative recipients. METHODS To better understand optimal immunosuppression for HIV-positive KT recipients, we studied associations between immunosuppression regimen, AR at 1 year, and survival in 516 HIV-positive and 93,027 HIV-negative adult kidney-only recipients using Scientific Registry of Transplant Recipients data from 2003 to 2011. RESULTS Consistent with previous reports, HIV-positive patients had twofold higher risk of AR (adjusted relative risk [aRR], 1.77; 95% confidence interval [CI], 1.45-2.2; P<0.001) than their HIV-negative counterparts as well as a higher risk of graft loss (adjusted hazard ratio, 1.51; 95% CI, 1.18-1.94; P=0.001), but these differences were not seen among patients receiving antithymocyte globulin (ATG) induction (aRR for AR, 1.16; 95% CI, 0.41-3.35, P=0.77; adjusted hazard ratio for graft loss, 1.54; 95% CI, 0.73-3.25; P=0.26). Furthermore, HIV-positive patients receiving ATG induction had a 2.6-fold lower risk of AR (aRR, 0.39; 95% CI, 0.18-0.87; P=0.02) than those receiving no antibody induction. Conversely, HIV-positive patients receiving sirolimus-based therapy had a 2.2-fold higher risk of AR (aRR, 2.15; 95% CI, 1.20-3.86; P=0.01) than those receiving calcineurin inhibitor-based regimens. CONCLUSION These findings support a role for ATG induction, and caution against the use of sirolimus-based maintenance therapy, in HIV-positive individuals undergoing KT.
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ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant 2014; 28 Suppl 2:ii1-71. [PMID: 24026881 DOI: 10.1093/ndt/gft218] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abstract
There is a growing need for kidney and liver transplants in persons living with HIV. Fortunately, with the significant advances in antiretroviral therapy and management of opportunistic infections, HIV infection is no longer an absolute contraindication for solid organ transplantation. Data from several large prospective multi-center cohort studies have shown that solid organ transplantation in carefully selected HIV-infected individuals is safe. However, significant challenges have been identified including prevention of acute rejection, management of drug-drug interactions and treatment of recurrent viral hepatitis. This article reviews the selection criteria, outcomes, and special management considerations for HIV-infected patients undergoing liver or kidney transplantation.
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Gathogo EN, Hamzah L, Hilton R, Marshall N, Ashley C, Harber M, Levy JB, Jones R, Boffito M, Khoo SH, Drage M, Bhagani S, Post FA. Kidney transplantation in HIV-positive adults: the UK experience. Int J STD AIDS 2013; 25:57-66. [PMID: 23970634 DOI: 10.1177/0956462413493266] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
HIV-positive patients are at increased risk of end-stage kidney disease (ESKD). Kidney transplantation (KT) is an established treatment modality for ESKD in the general population. Recent data have confirmed the feasibility of kidney transplantation in HIV-positive patients, and kidney transplantation is increasingly offered to ESKD patients with well-controlled HIV infection. We report clinical outcomes in a national cohort study of kidney transplantation in HIV-positive patients. In all, 35 HIV-positive KT recipients who had undergone KT up to December 2010 (66% male, 74% black ethnicity) were identified; the median CD4 cell count was 366, all had undetectable HIV RNA levels at kidney transplantation, and 44% received a kidney from a live donor. Patient survival at 1 and 3 years was 91.3%, and graft survival 91.3% and 84.7%, respectively. At one-year post-kidney transplantation, the cumulative incidence of acute rejection was 48%, and the median (IQR) eGFR was 64 (46, 78) mL/min/1.73 m(2). Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of kidney transplantation in HIV-positive patients. The high rates of acute rejection suggest that the optimal immune suppression strategy in this population remains to be refined.
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Mazuecos A, Fernandez A, Zarraga S, Andres A, Rodriguez-Benot A, Jimenez C, Gomez E, Paul J, Jimeno L, Fernandez C, Burgos D, Sanchez-Fructuoso A, Guirado L. High incidence of delayed graft function in HIV-infected kidney transplant recipients. Transpl Int 2013; 26:893-902. [DOI: 10.1111/tri.12147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/08/2013] [Accepted: 06/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ana Fernandez
- Renal Transplant Unit; Hospital Ramon y Cajal; Madrid; Spain
| | - Sofia Zarraga
- Renal Transplant Unit; Hospital de Cruces; Barakaldo; Spain
| | - Amado Andres
- Renal Transplant Unit; Hospital Doce de Octubre; Madrid; Spain
| | | | | | - Ernesto Gomez
- Renal Transplant Unit; Hospital Central de Asturias; Oviedo; Spain
| | - Javier Paul
- Renal Transplant Unit; Hospital Miguel Servet; Zaragoza; Spain
| | - Luisa Jimeno
- Renal Transplant Unit; Hospital Virgen de la Arrixaca; Murcia; Spain
| | | | - Dolores Burgos
- Renal Transplant Unit; Hospital Carlos Haya; Malaga; Spain
| | | | - Lluis Guirado
- Renal Transplant Unit; Fundacion Puigvert; Barcelona; Spain
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39
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Chin-Hong P, Beatty G, Stock P. Perspectives on liver and kidney transplantation in the human immunodeficiency virus-infected patient. Infect Dis Clin North Am 2013; 27:459-71. [PMID: 23714349 DOI: 10.1016/j.idc.2013.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Human immunodeficiency virus (HIV) infection is no longer an absolute contraindication for transplantation for patients with advanced kidney and liver failure. This article reviews the outcome data in the solid organ transplantation of HIV-infected patients that led to a change in thinking by the transplant community. Several emerging issues are also reviewed, such as eligibility criteria, selection of optimal immunosuppression agents and antiretroviral therapy in this population, and management of coinfection with hepatitis B and hepatitis C after transplant.
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Affiliation(s)
- Peter Chin-Hong
- Department of Medicine, University of California at San Francisco, San Francisco, CA 94143-0654, USA
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40
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Pretransplantation pharmacokinetic curves of tacrolimus in HIV-infected patients on ritonavir-containing cART: a pilot study. Transplantation 2013; 95:397-402. [PMID: 23250333 DOI: 10.1097/tp.0b013e3182734651] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Ritonavir is an extremely strong inhibitor of P450 cytochrome 3A, which is the main metabolizing enzyme of tacrolimus. Subsequently, the pharmacokinetics of tacrolimus are affected to a large extend by the coadministration of ritonavir in HIV-infected transplant recipients. Therefore, to prevent overexposure directly posttransplantation in HIV-infected patients on ritonavir-containing cART, the predictive value of a pretransplantation pharmacokinetic curve of tacrolimus was explored. METHODS A pretransplantation pharmacokinetic model of tacrolimus in these patients was developed, and a posttransplantation dosing advice was established for each individual patient. The pharmacokinetic population parameters were compared with HIV-negative patients, and predictive value of the pretransplantation curves was assessed in patients after the transplantation procedure. RESULTS No significant difference was found between the model-predicted and actual posttransplantation 24 h-tacrolimus levels (14.6 vs. 17.8 ng/mL, P=0.19). As the simulated pharmacokinetic curves lacked an absorption peak every 12 h, the mean 12 h-AUC was approximately 40 % lower compared with AUC's reported in HIV-negative recipients, when similar trough levels were targeted. CONCLUSION In conclusion, pretransplantation curves of tacrolimus seem a promising tool to prevent overexposure directly posttransplantation in patients on ritonavir-containing cART and raising trough levels to achieve an exposure equivalent to HIV-negative recipients is suggested.
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Pulzer A, Seybold U, Schönermarck U, Stangl M, Habicht A, Bogner JR, Franke J, Fischereder M. Calcineurin inhibitor dose-finding before kidney transplantation in HIV patients. Transpl Int 2012; 26:254-8. [DOI: 10.1111/tri.12020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/26/2012] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Alina Pulzer
- Division of Nephrology; Medizinische Klinik und Poliklinik IV; Ludwig-Maximilians-University; Munich; Germany
| | - Ulrich Seybold
- Division of Infectious Diseases; Medizinische Klinik und Poliklinik IV; Ludwig-Maximilians-University; Munich; Germany
| | - Ulf Schönermarck
- Division of Nephrology; Medizinische Klinik und Poliklinik IV; Ludwig-Maximilians-University; Munich; Germany
| | - Manfred Stangl
- Department of Surgery; Ludwig-Maximilians-University; Munich; Germany
| | - Antje Habicht
- Transplant Centre; Ludwig-Maximilians-University; Munich; Germany
| | - Johannes R. Bogner
- Division of Infectious Diseases; Medizinische Klinik und Poliklinik IV; Ludwig-Maximilians-University; Munich; Germany
| | - Jörg Franke
- Department of Nephrology and Hypertension; Schwabing General Hospital; Munich; Germany
| | - Michael Fischereder
- Division of Nephrology; Medizinische Klinik und Poliklinik IV; Ludwig-Maximilians-University; Munich; Germany
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Abstract
Antiretroviral therapy has been immensely successful in reducing the incidence of opportunistic infections and death after HIV infection. This has resulted in heightened interest in noninfectious comorbidities including kidney disease. Although HIV-associated nephropathy, the most ominous kidney disease related to the direct effects of HIV, may be prevented and treated with antiretrovirals, kidney disease remains an important issue in this population. In addition to the common risk factors for kidney disease of diabetes mellitus and hypertension, HIV-infected individuals have a high prevalence of other risk factors, including hepatitis C and exposure to antiretrovirals and other medications. Therefore, the differential diagnosis is vast. Early identification (through efficient screening) and prompt treatment of kidney disease in HIV-infected individuals are critical to lead to better outcomes. This review focuses on clinical and epidemiological issues, treatment strategies (including dialysis and kidney transplantation), and recent advances among kidney disease in the HIV population.
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Kidney transplantation in HIV-positive patients: a report of 14 cases. J Int AIDS Soc 2012. [PMCID: PMC3512470 DOI: 10.7448/ias.15.6.18111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The HAART reduces the risk of HIV-related renal disease but the incidence of end-stage renal disease (ESRD). Therefore, efficacy and safety of renal transplantation (Tx) is an important resource in the HIV-infected population. We reported the results of kidney Tx in HIV+patients from deceased donors from June 2007 to March 2012 at our institution. The patients had to have CD4+T-cell counts≥200/mm3 and undetectable plasma HIV-RNA if on HAART. The induction immunosuppressive therapy consisted of metilprednisolone and basilixmab; tacrolimus and/or mycofenolic acid were used for maintenance therapy. The therapeutic drug monitoring (TDM) has been performed for the adjusting of both their doses [1]. A total of 14 patients underwent kidney Tx. They were on dialysis (haemodialysis=13, 92.9%; peritoneal=1, 7.1%) for 5±3.1 years and they were included on the Tx waiting list for 10±8 months. The baseline characteristics are showed in Table 1.Donor at baseline | | Mean age | 38±12.5 years | Deceased | 14/14 (100%) | High/unclassified infectious risk | 9 (64.29%) | Recipients | | Mean age | 44 years | Patients with previous AIDS-defining events | 3 (21.4%) | Median follow-up months (IQR range) | 42.75 (8.5–55.2) | Patient survival at last follow-up | 14/14 (100%) | Graft survival at last follow-up | 13/14 (92.9%) | Mean time of acute rejection since Tx | 28±20 days | Patients not treated with steroid at last follow-up | 6 (43%) | Plasma creatinine at last follow-up | 1.87±1.93 mg/dl | Severe infectious complications (CMV pneumonia, malaria, Kaposi sarcoma) | 3 (21.4%) | Diabetes | 3 (21.4%) | CMV infection without localization | 3 (21.4%) | Bacterial pneumonia | 4 (28.6%) | Reactivation of HIV RNA | 3 (21.4%) |
At the last available point of follow-up (median=42.8 months, IQR=8.5–55.2), 8 out of the 13 patients (61.6%) without steroid had at least one acute rejection episode, but only 1 patient lost the graft, after 43 months (7.1%) due to chronic rejection associated with infectious and vascular complications. After Tx the median CD4+T-cell count increased from 382.5 (IQR range=233–415) to 434 (IQR range=282–605) cells/mm3 (p=0.055). In Figure 1 are reported the CD4+trends of 9 patients with a follow-up of at least 6 months. HIV infection was well controlled, with only 2 (14.3%) cases of virological failure which were promptly resolved after HAART regimen modification. Table 1 shows the observed infectious complications. The skin Kaposi sarcoma has been resolved by switching to immunosuppressive therapy with sirolimus [2]. Kidney Tx appears to be safe in HIV-positive patients undergoing HAART. The viro-immunological parameters remained well controlled with no increases in infectious complications or neoplasm and a satisfactory control of HIV infection. However, the high rejection rate is a serious concern and suggests to consider a steroid-containing immunosuppressive regimen also in these patients.![]()
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45
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Eleventh International Congress on Drug Therapy in HIV Infection. J Int AIDS Soc 2012. [DOI: 10.7448/ias.15.6.18447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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46
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van Maarseveen EM, Rogers CC, Trofe-Clark J, van Zuilen AD, Mudrikova T. Drug-drug interactions between antiretroviral and immunosuppressive agents in HIV-infected patients after solid organ transplantation: a review. AIDS Patient Care STDS 2012; 26:568-81. [PMID: 23025916 DOI: 10.1089/apc.2012.0169] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Since the introduction of combination antiretroviral therapy (cART) resulting in the prolonged survival of HIV-infected patients, HIV infection is no longer considered to be a contraindication for solid organ transplantation (SOT). The combined management of antiretroviral and immunosuppressive therapy proved to be extremely challenging, as witnessed by high rates of allograft rejection and drug toxicity, but the profound drug-drug interactions between immunosuppressants and cART, especially protease inhibitors (PIs) also play an important role. Caution and frequent drug level monitoring of calcineurin inhibitors, such as tacrolimus are necessary when PIs are (re)introduced or withdrawn in HIV-infected recipients. Furthermore, the pharmacokinetics of glucocorticoids and mTOR inhibitors are seriously affected by PIs. With the introduction of integrase inhibitors, CCR5-antagonists and fusion inhibitors which cause significantly less pharmacokinetic interactions, have minor overlapping toxicity, and offer the advantage of pharmacodynamic synergy, it is time to revaluate what may be considered the optimal antiretroviral regimen in SOT recipients. In this review we provide a brief overview of the recent success of SOT in the HIV population, and an update on the pharmacokinetic and pharmacodynamic interactions between currently available cART and immunosuppressants in HIV-infected patients, who underwent SOT.
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Affiliation(s)
| | - Christin C. Rogers
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer Trofe-Clark
- Department of Pharmacy, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania
| | - Arjan D. van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Tania Mudrikova
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, The Netherlands
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Abstract
Infections are a major cause of morbidity and mortality in kidney transplant recipients. To some extent, these may be preventable. Careful pretransplant screening, immunization, and post-transplant prophylactic antimicrobials may all reduce the risk for post-transplant infection. However, because transplant recipients may not manifest typical signs and symptoms of infection, diagnoses may be confounded. Furthermore, treatment regimens may be complicated by drug interactions and the need to maintain immunosuppression to avoid allograft rejection. This article reviews common post-transplant infections, including prophylactic, diagnostic, and treatment strategies, providing guidance regarding care of kidney transplant patients with infection.
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Affiliation(s)
- Shamila Karuthu
- Division of Nephrology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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48
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Current world literature. Curr Opin Oncol 2012; 24:587-95. [PMID: 22886074 DOI: 10.1097/cco.0b013e32835793f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Miró JM, Blanes M, Norman F, Martín-Dávila P. Infections in solid organ transplantation in special situations: HIV-infection and immigration. Enferm Infecc Microbiol Clin 2012; 30 Suppl 2:76-85. [DOI: 10.1016/s0213-005x(12)70086-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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50
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Akhtar M, Patel N, Devaney A, Sinha S, Shankar S, Vaidya A, Friend P. Simultaneous Pancreas Kidney Transplantation in the HIV-Positive Patient. Transplant Proc 2011; 43:3903-4. [DOI: 10.1016/j.transproceed.2011.08.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/04/2011] [Indexed: 11/29/2022]
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