Good Outcomes with HIV-Positive Kidney Donors and Recipients

At up to 5 years of follow-up, HIV-positive recipients of kidney transplants from HIV-positive donors have good graft survival and other outcomes, reports a study in the New England Journal of Medicine.

The experience included kidney transplants in 27 HIV-infected patients at a South African transplantation center from 2008 to 2014. All patients were receiving antiretroviral therapy (ART), with a CD4 T cell count of at least 200 mm3 and undetectable plasma HIV RNA.

Kidneys were obtained from 23 deceased donors, all positive for HIV by fourth-generation enzyme-linked immunosorbent assay. The donors had received no or only first-line ART. The surviving recipients were followed up for a median of 2.4 years.

Patient survival was 84 percent at 1 and 3 years and 74 percent at 5 years. Graft survival rates were 93 percent, 84 percent, and 84 percent, respectively. Five patients had a total of eight confirmed episodes of acute rejection; the rejection rate was 8 percent at 1 year and 22 percent at 3 years. The patients’ HIV disease remained well controlled, with continued suppression of viral load.

The successful rollout of ART in South Africa has led to an increased number of patients with diagnoses of HIV nephropathy. Kidneys from HIV-infected donors provide a promising alternative to dialysis for these patients.

The new experience shows good graft functioning and patient survival after kidney transplantation from HIV-positive deceased donors to HIV-positive recipients. The outcomes appear similar to those in high-risk kidney transplant patients without HIV infection. The authors discuss the challenges related to interactions between antiretroviral and immunosuppressant drugs [Muller E, et al. HIV-positive–to–HIV-positive kidney transplantation: results at 3 to 5 years. N Engl J Med 2015; 372:613–620].