Melissa Schorr

Medscape Medical News 2005. © 2005 Medscape
 

May 25, 2005 (Seattle) — HIV-positive patients have equally good outcomes after kidney transplant as HIV-negative patients do and should not be denied kidney transplants, according to research presented here at the American Transplant Congress 2005: 6th Annual Joint Meeting of the American Society of Transplant Surgeons and the American Society of Transplantation.

"The graft and patient outcomes of HIV-positive kidney recipients are comparable to those in the HIV-negative population," lead author Silas P. Norman, MD, a clinical assistant professor in the nephrology department at the University of Michigan, Ann Arbor, told Medscape. "This should encourage the transplant community to expand opportunities for transplants."

Dr. Norman conducted a retrospective study looking at patients who received kidney transplants between Jan. 1, 1987, and July 31, 2004, using data from the Scientific Registry of Transplant Recipients.

While HIV-positive status was once a contraindication for kidney transplantation, but in the era of highly-active antiretroviral therapy (HAART), outcomes have been greatly improved, Dr. Norman said. In the database, there were only 29 transplants of HIV-positive individuals made between 1987 through 1995.

The study looked at the outcomes for 178 HIV-positive kidney transplant recipients — 114 from deceased donors and 64 from living donors — compared with nearly 150,000 HIV-negative recipients.

The recipients were similar in age at transplantation, age of donor, cold-ischemia time, and HLA mismatch. However, the HIV-positive patients were more likely to have end-stage renal disease caused by hypertension rather than other causes, such as diabetes. The HIV-positive kidney recipients were also more likely to be African American and male than the HIV-negative recipients.

The researchers found that the risk for graft failure significantly declined for patients from the post-HAART era compared with those transplanted in the pre-HAART era, which they dated from Jan. 1, 1996. The one-year graft survival rate for HIV-positive recipients rose from 75% to 84% from the pre-HAART to post-HAART era.

In the post-HAART era, Dr. Norman said, there was no significant difference in patient or graft survival rates. The one-year patient survival rate was 94% among the HIV-negative recipients and 92% among those who were HIV-positive, which was not statistically significant.

"Kidney transplants can be performed safely and yield good outcomes," Dr. Norman told attendees. "HIV status should no longer be considered a contraindication. HIV-positive patients with end-stage kidney disease should be referred to a transplant center at this point for evaluation."

Ginny Bumgardner, MD, PhD, an associate professor of surgery at Ohio State University in Columbus, who moderated the panel, said the research provided valuable information about the appropriateness of HIV-positive patients undergoing a transplantation. "It is giving long-term results in a high-risk group. We need to continue to follow-up."

The researchers reported there were no financial disclosures.

ATC 2005: 6th Annual Joint Meeting of the American Society of Transplant Surgeons and the American Society of Transplantation: Abstract 536. Presented May 23, 2005.

Reviewed by Gary D. Vogin, MD