Kidney Transplantation in HIV-positive Patients: Current Practice and Management Strategies

Abstract

Background: HIV positive patients had been successfully transplanted for the last 15 years and the donor pool had successfully been expanded to also include HIV positive donors. Methods: We aimed to evaluate the effectiveness of transplantation in HIV positive patients and highlight some of the important issues reported in the literature. We pooled clinical data form different cohorts in order to show some of the common issues encountered in HIV positive transplantation. Furthermore we searched MEDLINE via PubMed, EMBASE, Cochrane CENTRAL to create a comprehensive table for current evidence for different issues currently encountered when transplanting HIV positive patients. Results: We included data from 19 cohort studies and reported on outcomes of the current HIV positive transplant programs. We made recommendations based on personal experience as well as the experience reported in the literature regarding rejection, opportunistic infection and HIV associated nephropathy. Opportunistic infections and malignancies are not a major problem for this population group. Conclusions: HIV positive patients encounter very specific issues after transplantation, specifically related to drug interactions and higher rejection rates. When utilizing HIV positive donors, the recurrence of HIV Associated nephropathy in the graft kidney is an issue which can be important. Despite some issues with high rejection rates, HIV positive patients have similar results to HIV negative patients post transplantation.