COMPLICATIONS - INFECTIONS

A. Mazuecos¹, R. Marcén², A. Andrés³, E. Gómez⁴, S. Zárraga⁵, D. Burgos⁶, C. Jiménez⁷, J. Paul⁸, A. Rodríguez-benot⁹, C. Fernández^10
1, Hospiatal Universitario Puerta del Mar, Cádiz/SPAIN, ², Hospital Universitario Ramón y Cajal, Madrid/SPAIN, ³Servicio De Nefrología, Hospital 12 de Octubre, Madrid/SPAIN, ⁴, Hospital Universitario Central de Asturias, Oviedo/SPAIN, ⁵, Hospital de Cruzes, Barakaldo/SPAIN, ⁶, Hospital Regional Universitario Carlos Haya, Málaga/SPAIN, ⁷, Hospital Universitario La Paz, Madrid/SPAIN, ⁸, Hospital Universitario Miguel Servet, Zaragoza/SPAIN, ⁹, Hospital Universitario Reina Sofía, Córdoba/SPAIN, ¹⁰, Hospital Universitario de A Coruña, La Coruña/SPAIN

Body: Introduction: HIV infection is no longer a contraindication for kidney transplantation (KT). Some aspects, such as the acute rejection (AR) rate reported and the impact of co-infection by hepatitis C virus (HCV), are still controversial. Moreover, almost all the studies reported correspond to transplant patients in the USA with different epidemiological characteristics to our own population, which might impact post-transplantation evolution (higher number of live donors, higher prevalence of Afro-American recipients). Our aim was to analyse the survival rate of KT in patients with HIV infection in our country and compare it to HIV-negative kidney transplantation patients in a retrospective multicentre case and control study (1:2). Methods: Between 2001 and March 2009, 20 KT were performed in HIV-positive patients in 10 Spanish hospitals that were compared to a matched control group of 40 HIV-negative patients transplanted in the same period and in the same hospitals, selected according to known risk factors for survival in KT. Several pre-KT variables (demographic data, cause of chronic kidney disease, comorbidity, type of and time on dialysis and specific data of the HIV and HCV population), donors and the evolution of the KT (HLA mismatches, peak panel reactive antibodies, cold ischemia time, immunosuppression, renal function, post-KT complications) were compared. Results: The post-KT follow-up time was 3.2+2.2 years. Most of the recipients were white (96.6%) and received cadaveric donor grafts (98.3%). The time on dialysis until the KT (6.53 + 5.62 vs 2.68 + 2.71 years; p=0.002) and the incidence of pre-KT opportunistic infections (50% vs 15%; P=0.006) was greater in the HIV-positive recipients. There were no differences in other pre-KT variables or donor characteristics. Following the KT, the HIV-positive patients presented a lower incidence of immediate renal function (40% vs 75%, p=0.01) and more AR (40% vs 22.5%). Death-censored graft survival was worse in the HIV-positive recipients (1 year: 85% vs 97.5%; 3 years: 74.4% vs 97.5%; 5 years: 74.4% vs 91%; p=0.058). There were no differences in patient survival. Eight patients in each group presented HCV infection. The co-infected patients (HIV+/HCV+) were compared to the HIV+/HCV- and the HIV-/HCV+ recipients. Patients with HIV/HCV co-infection presented more pre-KT time on dialysis, a greater background of drug addiction and greater duration of delayed graft function (DGF) than the other groups, and death-censored graft survival was significantly worse (HIV+/HCV+ vs HIV+/HCV-: p=0.009; HIV+/HCV+ vs HIV-/HCV+: p=0.02). On the other hand, on comparing graft survival in HIV+ and HIV- patients excluding HCV+ patients in both groups, graft survival was similar (HIV+/HCV-, 100%; HIV-/HCV-, 96.8%; p=0.39). Conclusions: As in other American studies, the incidence of AR and DGF was superior in the HIV-positive patients. Nevertheless, graft survival is good, particularly in non-HIV/HCV co-infected patients. Patients with HIV/HCV co-infection are a special risk group for KT.

Disclosure: All authors have declared no conflicts of interest.