Kidney Transplant for HIV-Infected Patients With ESRD?

Renal complications are common and serious among HIV-infected patients, although the advent of antiretroviral therapy has improved outcomes of HIV patients with end-stage renal disease (ESRD).¹ Some carefully selected patients with controlled HIV may be eligible for kidney transplants. However it is not clear if kidney transplants offer an improved survival over renal replacement therapy in these patients.

A new study published in the Journal of Acquired Immune Deficiency Syndromes examined the patterns of kidney transplant in HIV-positive patients and compared the outcomes of these patients with those managed with dialysis alone.² The investigators looked at all patients with stage 5 chronic kidney disease in the United Kingdom Collaborative HIV Cohort (UK CHIC) and all HIV-positive patients who had received permanent renal replacement therapy. They also identified patients who were eligible for transplant, whether they actually received one or not.²

The study found a 3.8-fold increase in the prevalence of ESRD among black patients in the UK CHIC cohort.² There was a continued rise in the number of HIV-positive patients with ESRD during the 12-year study period.² Out of 107 patients with the diagnosis of ESRD, 69 (64%) were considered eligible for kidney transplant but only 34 (32%) had actually received a transplant. Interestingly, the investigators found no difference in survival between transplant recipients and those awaiting a transplant on dialysis at 5 years (85% and 89%, respectively; P=.53).² The authors suggest that renal transplant in this patient population may only provide a long-term survival-advantage and the more immediate benefits will most likely be seen in quality of life measures, cardiovascular comorbidity, and cost of care, all areas for future study.²

References:

• Bansi L, Hughes A, Bhagani S, et al. Clinical epidemiology of HIV-associated end-stage renal failure in the UK. AIDS. 2009;23:2517–2521
• Gathogo  E, Jose S, Jones R, et al. End-stage kidney disease and kidney transplantation in HIV-positive patients: an observational cohort study. J Acquir Immune Defic Syndr. 2014; 67:177–180. doi: 10.1097/QAI.0000000000000291.