Update on kidney transplantation in human immunodeficiency virus infected recipients

Abstract

Improved survival of human immunodeficiency virus (HIV) infected patients with chronic kidney disease following the introduction of antiretroviral therapy resulted in the need to revisit the topic of kidney transplantation in these patients. Large cohort studies have demonstrated favorable outcomes and proved that transplantation is a viable therapeutic option. However, HIV-infected recipients had higher rates of rejection. Immunosuppressive therapy did not negatively impact the course of HIV infection. Some of the immunosuppressive drugs used following transplantation exhibit antiretroviral effects. A close collaboration between infectious disease specialists and transplant professionals is mandatory in order to optimize transplantation outcomes in these patients. Transplantation from HIV⁺ donors to HIV⁺ recipients has been a subject of intense debate. The HIV Organ Policy Equity act provided a platform to research this area further and to develop guidelines. The first HIV⁺ to HIV⁺ kidney transplant in the United States and the first HIV⁺ to HIV⁺ liver transplant in the world were recently performed at the Johns Hopkins University Medical Center.

Keywords: End-stage kidney disease; Human immunodeficiency virus; Antiretroviral therapy; Kidney transplantation

Core tip: Experience with kidney transplantation in human immunodeficiency virus (HIV) positive patients is evolving. With appropriate selection of candidates, the outcomes appear similar to that in HIV negative population. There are challenges with kidney transplantation in HIV positive patients including increased risk for acute rejection and drug-drug interactions. Optimal immunosuppressive regimen is unknown. This article discusses the recent advances in kidney transplantation among HIV positive patients.