Kidney transplantation in HIV-positive patients

Chronic kidney disease is a serious complication of HIV-infection. Its progression inevitably leads to end-stage renal disease (ESRD). The prevalence of ESRD in HIV-positive patients is 2-20 times higher than in the general population. Until 1996, hemodialysis was dominant in the ESRD treatment in HIV infected patients, while kidney transplantation was considered a contraindication due to the potential risks of chronic immunosuppression exacerbating HIV-related immune dysfunction. In the small number of HIV-positive patients transplanted at that time, outcomes were generally poor. Interest in kidney transplantation in HIV-infection aroused with the beginning of antiretroviral therapy (ART). The very first experience in this field under the new conditions showed good outcomes, confirmed later in a multicenter trial funded by US National Institute of Health. Contemporary studies have now demonstrated that renal transplantation is a safe and effective treatment of ESRD in HIV patients, with patient and allograft survival rates similar to those in uninfected patients. According to a meta-analysis summarizing data from 27 cohort studies covering 1,670 kidney transplantations in HIV-positive patients from 2003 to 2018, the one-year patients’ survival rate was 97%, the graft survival rate was 91%, and three-year survival rates were 94% and 81%, respectively. To date, criteria have been formulated for donor and potential recipient’s selection. It is generally recognized that a potential recipient should be treated with ART for at least 6 months before surgery, have an undetectable viral load and a CD4 cell count >200 per μl. Opportunistic infections use to be exclusion criteria, but several centers allow some of them as potentially curable. The experience in transplantation in HIV-infection has identified unique challenges including high rates of acute rejection, delayed graft function, and significant drug-drug interactions. This article discusses current experience in the field of kidney transplantation in HIV-infection and presents two of our clinical cases illustrating the long post-transplant course.

ВИЧ-инфекция, трансплантация почки, пост-трансплантационная иммуносупрессия, отторжение трансплантата, отсроченная функция трансплантата, антиретровирусная терапия, лекарственное взаимодействие, HIV-infection, kidney transplantation, posttransplant immunosuppression, transplant rejection, delayed graft function, antiretroviral therapy, drug-drug interactions

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