HIV positive kidney transplant recipients who are not infected with hepatitis C virus (HCV) have similar kidney and patient survival rates as HIV negative recipients, according to a study conducted by researchers at the University of Alabama at Birmingham. The article, entitled “A National Study of Outcomes among HIV-infected Kidney Transplant Recipients," is published online ahead of print in Journal of the American Society of Nephrology (JASN). The findings suggest that excellent outcomes can be achieved among HIV positive kidney transplant recipients.

Chronic diseases represent the leading cause of death among HIV positive individuals. Kidney transplantation is now offered as an acceptable treatment option for HIV positive patients with end-stage renal disease, although experience with HIV positive kidney transplantation is in its relative infancy.

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“Understanding long-term outcomes among HIV positive kidney transplant recipients is paramount to ensure continued access to life saving kidney transplantation for this vulnerable population,” said study author Jayme Locke, MD, MPH, FACS, from the University of Alabama at Birmingham).

To get a better understanding of the long-term health of HIV positive patients who undergo kidney transplantation, Dr. Locke and her colleagues examined the health of the US HIV positive kidney transplant population from 2002 to 2011. During that time, 510 HIV positive adults underwent kidney transplantation. These patients were matched 1:10 with HIV negative adults who underwent kidney transplantation.

Among the major findings:
 

• Overall, 5- and 10-year kidney survival rates were significantly lower among HIV positive recipients compared with HIV negative recipients (69% vs. 75% and 50% vs. 54%, respectively); however, when limited to patients without HCV, mono-infected HIV positive recipients had similar 5-year and 10-year kidney survival rates compared with uninfected recipients.
• Overall, patient survival among HIV positive recipients was significantly lower than survival rates of HIV negative recipients; however, when limited to patients without HCV, rates were similar for mono-infected HIV positive recipients and uninfected recipients at both time points.
• HIV positive recipients co-infected with HCV had inferior kidney and patient survival rates.

The findings reveal that HIV positive kidney transplant recipients who are not infected with HCV have similar kidney and patient survival rates as HIV negative recipients. Importantly, though, almost 25% of HIV positive kidney transplant recipients are co-infected with HCV, compared with only 5% of the general kidney transplant recipient population. This study’s results suggest caution in transplanting co-infected patients.

“Locke and colleagues should be commended for providing a national perspective on the status of HIV transplantation which supports the expanded use of kidney transplantation in this group,” wrote Alissa Wright, MD and John Gill, MD, MS, from the University of British Columbia, in Canada, in an accompanying editorial.

Study co-authors include Shikha Mehta, MD, Rhiannon Reed, MPH, Paul MacLennan, PhD, Allan Massie, PhD, Anoma Nellore, MD, Christine Durand, MD, and Dorry Segev MD, PhD.

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