TORONTO—One- and three-year outcomes for both patient and graft survival among HIV-infected transplant recipients are comparable to those in the overall transplant population, data show. The findings come from the largest, prospective cohort of HIV-infected kidney and liver transplant recipients followed since the introduction of highly active antiretroviral therapy, researchers say.
Additionally, immunosuppressive regimens in these patients have not been associated with dramatic declines in CD4 cell counts or development of AIDS-related opportunistic infections, at least not at a median follow-up of 3.4 years after kidney transplantation and 2.5 years after liver transplantation.
“Our main conclusion is that [HIV-infected] patients are doing really well, they are not dying any more frequently than HIV-negative transplant recipients, and we are able to manage complicated drug interactions in these patients and keep the virus suppressed,” said Michelle Roland, MD, associate professor of medicine at the University of California in San Francisco. Dr. Roland presented outcome data here at the 16th International AIDS Conference.
Between 2000 and 2003, 18 HIV-infected patients with a median age of 44 received a kidney transplant and 11 HIV-infected patients with a median age of 46 years received a liver transplant. At the time of transplantation, the median CD4 cell count was 439 cells/mm3 for kidney recipients and 249 cells/mm3 for liver recipients. Viral loads were undetectable in both groups. Six liver recipients had hepatitis C, as did five kidney recipients. Five liver recipients, but no kidney recipients, had hepatitis B. Kidney recipients had a survival rate of 94% at both one and three years. The patient survival rate among the liver recipients was 91% at one year and 72% at three years. Rates of graft survival at one and three years were 83% at both time points for kidney recipients and 82% and 72%, respectively, for liver recipients.
Severe acute rejection, chronic rejection, and chronic allograft nephropathy resulted in three kidney graft losses. Interestingly, investigators observed more rejection in this cohort of HIV-infected kidney transplant patients than is normally seen in HIV-negative transplant recipients. Still, “we’re not losing grafts more frequently in this group of patients, and kidney function is relatively well preserved, despite these frequent rejection episodes,” Dr. Roland said. Understanding why these episodes occur is a high priority in their ongoing study. For more information about the study, which is enrolling patients at 20 U.S. transplant centers, go to http://www.hivtransplant.com/.