Study Backs Kidney Transplants in People With HIV

Patient, graft survival high in following years, but rejection rates unexpectedly high

WEDNESDAY, Nov. 17 (HealthDay News) -- Kidney transplantation appears feasible in certain patients with HIV, though better strategies for minimizing rejection may be needed, according to research published in the Nov. 18 issue of the New England Journal of Medicine.

Peter G. Stock, M.D., of the University of California in San Francisco, and colleagues analyzed data from 150 patients with HIV infection who underwent kidney transplantation. They had CD4+ T-cell counts of 200 per cubic millimeter or higher and undetectable plasma HIV type 1 RNA levels while using a stable antiretroviral regimen.

The researchers found that rates of patient survival were 94.6 percent at one year and 88.2 percent at three years. Mean graft survival rates at these points were 90.4 and 73.7 percent, respectively. Risk of graft loss was higher in patients treated for rejection (hazard ratio, 2.8) and for those on antithymocyte globulin induction therapy (hazard ratio, 2.5). Rejection rates were higher than anticipated (one-year estimates of 31 percent and three-year estimates of 41 percent).

"Given recent advances in our understanding of the genetic predisposition to HIV-associated nephropathy, as well as the study by Stock et al. showing the feasibility of kidney transplantation, we can hope for a surge in clinical advances in the treatment of HIV-related kidney disease," writes the author of an accompanying editorial.

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