HIV associated nephropathy surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Overview

Kidney transplantation is increasing in HIV-positive patients with end-stage renal disease (ESRD).[1] Although the rejection rate is high, the graft survival rates are high.[2][3] Recently reports have shown successful kidney transplantation from HIV-positive donors to HIV-positive recipients.[4][5]

HIV Associated Nephropathy Surgery

Kidney Transplantation

  • Kidney transplantation in HIV-positive patients with end-stage renal disease (ESRD) is increasing.[1]
  • A study reported a two to threefold increase in kidney rejection in patients with HIV-positive compared to HIV-negative.[2].
  • In one study the incidence of rejection was 31% and 41% at 1 and 3 years, respectively.[2] In another study the acute rejection rate was 18% and 27% at 1 and 3 years, respectively.[3]
  • The high rejection rate require more effective immunotherapy.[2]
  • Graft survival rates were 90.4% and 73.7% at 1 and 3 years,[2] respectively in one study and 100% and 81%, respectively in another study.[3]
  • Recently, there have been reports of successful kidney transplantation from HIV-positive donors to HIV-positive recipients.[4][5]
    • HIV superinfection and resistance to cART are among the most concerning risks in kidney transplantation in HIV-positive kidneys to HIV-positive recipients.[6]

References

  1. 1.0 1.1 Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA; et al. (2018). "HIV-associated nephropathy: links, risks and management". HIV AIDS (Auckl). 10: 73–81. doi:10.2147/HIV.S141978. PMC 5975615. PMID 29872351.
  2. 2.0 2.1 2.2 2.3 2.4 Stock PG, Barin B, Murphy B, Hanto D, Diego JM, Light J; et al. (2010). "Outcomes of kidney transplantation in HIV-infected recipients". N Engl J Med. 363 (21): 2004–14. doi:10.1056/NEJMoa1001197. PMC 3028983. PMID 21083386.
  3. 3.0 3.1 3.2 Waheed S, Sakr A, Chheda ND, Lucas GM, Estrella M, Fine DM; et al. (2015). "Outcomes of Renal Transplantation in HIV-1 Associated Nephropathy". PLoS One. 10 (6): e0129702. doi:10.1371/journal.pone.0129702. PMC 4463848. PMID 26061701.
  4. 4.0 4.1 Muller E, Barday Z, Mendelson M, Kahn D (2015). "HIV-positive-to-HIV-positive kidney transplantation--results at 3 to 5 years". N Engl J Med. 372 (7): 613–20. doi:10.1056/NEJMoa1408896. PMC 5090019. PMID 25671253.
  5. 5.0 5.1 Durand CM, Segev D, Sugarman J (2016). "Realizing HOPE: The Ethics of Organ Transplantation From HIV-Positive Donors". Ann Intern Med. 165 (2): 138–42. doi:10.7326/M16-0560. PMC 4949150. PMID 27043422.
  6. Muller E, Barday Z (2018). "HIV-Positive Kidney Donor Selection for HIV-Positive Transplant Recipients". J Am Soc Nephrol. 29 (4): 1090–1095. doi:10.1681/ASN.2017080853. PMC 5875954. PMID 29330339.

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