Higher rates of rejection in HIV‐infected kidney transplant recipients on ritonavir‐boosted protease inhibitors: 3‐year follow‐up study
| Autor: | Brett Rollins, Ron Shapiro, Shirish Huprikar, Susan Lerner, Leandra Miko, Meenakshi Rana, Graciela DeBoccardo, Samira S. Farouk, Sander Florman, Veronica Delaney |
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| Rok vydání: | 2019 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty medicine.medical_treatment HIV Infections 030230 surgery Kidney Function Tests Gastroenterology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Risk Factors Internal medicine medicine Humans Dialysis Retrospective Studies Transplantation Creatinine Ritonavir business.industry Graft Survival HIV Immunosuppression Retrospective cohort study HIV Protease Inhibitors Middle Aged Prognosis Kidney Transplantation Tacrolimus Regimen chemistry Female 030211 gastroenterology & hepatology business Follow-Up Studies Glomerular Filtration Rate medicine.drug |
| Zdroj: | Clinical Transplantation. 33 |
| ISSN: | 1399-0012 0902-0063 |
| Popis: | Rejection rates in HIV-infected kidney transplant (KTx) recipients are higher than HIV-negative recipients. Immunosuppression and highly active antiretroviral therapy (HAART) protocols vary with potentially significant drug-drug interactions, likely influencing outcomes. This is an IRB-approved, single-center, retrospective study of adult HIV-infected KTx patients between 5/2009 and 12/2014 with 3-year follow-up, excluding antibody-depleting induction. A total of 42 patients were included; median age was 52 years, 81% male, 50% African American, 29% Hispanic, 17% Caucasian. The most common renal failure etiology was hypertensive nephrosclerosis (50%) with 5.8 median years of pre-transplant dialysis. All patients received IL-2 receptor antagonist, were maintained on tacrolimus (76%) or cyclosporine (17%), and 40% received ritonavir-boosted PI-based HAART (rtv+) regimen. Patient and graft survival at 3 years were 93% and 90%. At 1-, 2-, and 3-year time points, median serum creatinine was 1.49, 1.35, and 1.67; treated biopsy-proven rejection was 38%, 38%, and 40.5%; and 92% of episodes were acute rejection. At these time points, rejection rates were significantly higher with boosted PI HAART regimens compared to other HAART regimens, 59% vs 24% (P = 0.029), 59% vs 24% (P = 0.029), and 68% vs 24% (P = 0.01). Despite higher rejection rates, HIV-infected KTx recipients have reasonable outcomes. Given significantly higher rejection rates using rtv+ regimens, alternative HAART regimens should be considered prior to transplantation. |
| Databáze: | OpenAIRE |
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