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Renal Transplant in HIV-Positive Patients:  Long-term Outcomes and Risk Factors for Graft Loss

Jayme E. Locke, MD, MPH; Robert A. Montgomery, MD, DPhil; Daniel S. Warren, PhD; Aruna Subramanian, MD; Dorry L. Segev, MD
Arch Surg. 2009;144(1):83-86. doi:10.1001/archsurg.2008.508.
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In the highly active antiretroviral therapy era of improved survival for patients living with human immunodeficiency virus (HIV), chronic kidney disease now accounts for more than 10% of HIV-related deaths. The role of kidney transplant among HIV-positive patients with end-stage renal disease is under consideration, but concerns remain regarding allocation of kidneys to these patients when long-term benefit has not been firmly established. We evaluated 39 501 patients undergoing a renal transplant between January 1, 2004, and June 30, 2006, identified through the United Network for Organ Sharing national registry and found that, although long-term allograft survival is lower among HIV-positive recipients, controllable risk factors may explain this disparity. With proper donor selection and transplant recipient management, including the avoidance of prolonged cold ischemic time, use of living donors, and determination of optimal immunosuppression dosing before transplant, long-term graft survival comparable to that in HIV-negative patients can be achieved.

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Figure.

Kidney graft survival by risk factor and human immunodeficiency virus (HIV) status. Death-censored graft survival (DCGS) rates by HIV status among recipients of kidneys from donors 50 years or older (A) and from donors younger than 50 years (B). The DCGS rates by HIV status among transplant recipients who developed delayed graft function (DGF) (C) and those who did not develop DGF (D). Each panel contains a graphic representation of the Kaplan-Meier survival function generated from the matched control data set. HIV-positive recipients (cases) and HIV-negative recipients (controls) were matched on donor type (living or deceased) and age; recipient age, race, history of diabetes, hepatitis C serostatus, and DGF; and cold ischemic time.

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