HIV infection and renal transplantation

Some aspects of kidney transplant outcome in human immunodeficiency virus (HIV)-infected patients are still controversial. Besides, published experience is scarce in Europe.

A multicentre case-control study was designed to analyse the outcome of renal transplant in HIV + patients in Spain. Twenty HIV + patients were compared with a matched cohort of 40 HIV - recipients.

Post-transplant follow-up period was 39.98 ± 36.51 months. Pre-transplant dialysis duration and the incidence of pre-transplant opportunistic infections were significantly higher for HIV + patients. Following transplantation, HIV + recipients presented lower incidence of immediate renal function and more acute rejection. Graft survival was lower although the difference was not significant (1 year: 85 vs 97.5%; 5 years: 74.4 vs 91%; log-rank P = 0.058). There was no difference in patient survival rates. Eight patients in each group presented hepatitis C (HCV) infection. Coinfected patients were compared with HIV +/HCV - and HIV -/HCV + recipients. Coinfected patients presented more time on dialysis, greater duration of delayed graft function and lower graft survival (HIV +/HCV + vs HIV +/HCV -: log-rank P = 0.009; HIV +/HCV + vs HIV -/HCV +: log-rank P = 0.02). Conversely, when excluding HCV + patients in both groups, graft survival in HIV + and HIV - patients was similar.

The outcome was good, particularly in non-coinfected patients. Coinfected patients constitute an especially high-risk group for kidney transplantation.