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Vicari AR, Spuldaro F, Sandes-Freitas TV, Cristelli MP, Requião-Moura LR, Reusing JO, Pierrotti LC, Oliveira ML, Girão CM, Gadonski G, Kroth LV, Deboni LM, Ferreira GF, Tedesco-Silva H, Esmeraldo R, David-Neto E, Saitovitch D, Keitel E, Garcia VD, Pacheco-Silva A, Medina-Pestana JO, Manfro RC. Renal transplantation in human immunodeficiency virus-infected recipients: a case-control study from the Brazilian experience. Transpl Infect Dis 2016; 18:730-740. [PMID: 27503081 DOI: 10.1111/tid.12592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/27/2016] [Accepted: 06/24/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy has turned human immunodeficiency virus (HIV)-infected patients with end-stage renal disease into suitable candidates for renal transplantation. We present the Brazilian experience with kidney transplantation in HIV-infected recipients observed in a multicenter study. METHODS HIV-infected kidney transplant recipients and matched controls were evaluated for the incidence of delayed graft function (DGF), acute rejection (AR), infections, graft function, and survival of patients and renal grafts. RESULTS Fifty-three HIV-infected recipients and 106 controls were enrolled. Baseline characteristics were similar, but a higher frequency of pre-transplant positivity for hepatitis C virus and cytomegalovirus infections was found in the HIV group. Immunosuppressive regimens did not differ, but a trend was observed toward lower use of anti-thymocyte globulin in the group of HIV-infected recipients (P = 0.079). The HIV-positive recipient group presented a higher incidence of treated AR (P = 0.036) and DGF (P = 0.044). Chronic Kidney Disease Epidemiology Collaboration estimated that glomerular filtration rate was similar at 6 months (P = 0.374) and at 12 months (P = 0.957). The median number of infections per patient was higher in the HIV-infected group (P = 0.018). The 1-year patient survival (P < 0.001) and graft survival (P = 0.004) were lower, but acceptable, in the group of HIV-infected patients. CONCLUSIONS In the Brazilian experience, despite somewhat inferior outcomes, kidney transplantation is an adequate therapy for selected HIV-infected recipients.
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Affiliation(s)
- A R Vicari
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - F Spuldaro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - M P Cristelli
- Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil
| | - L R Requião-Moura
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - J O Reusing
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - L C Pierrotti
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - M L Oliveira
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - C M Girão
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - G Gadonski
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L V Kroth
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L M Deboni
- Hospital Municipal São José e Fundação Pró-Rim, Joinville, SC, Brazil
| | - G F Ferreira
- Hospital Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - H Tedesco-Silva
- Hospital do Rim, Federal University of São Paulo, São Paulo, SP, Brazil
| | - R Esmeraldo
- Renal Transplant Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - E David-Neto
- Renal Transplant Unit, Hospital das Clínicas de São Paulo, University of São Paulo, São Paulo, SP, Brazil
| | - D Saitovitch
- Renal Transplant Unit, Hospital São Lucas, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - E Keitel
- Renal Transplant Unit, Hospital Santa Casa de Porto Alegre, Federal University of Medical Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - V D Garcia
- Renal Transplant Unit, Hospital Santa Casa de Porto Alegre, Federal University of Medical Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - A Pacheco-Silva
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - R C Manfro
- Renal Transplant Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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