Regional differences in the management and outcome of kidney transplantation in patients with human immunodeficiency virus infection: A 3‐year retrospective cohort study

• Published in: Transplant infectious disease Vol. 19; no. 4
• Main Authors: Cristelli, Marina P., Cofán, Federico, Tedesco‐Silva, Helio, Trullàs, Joan Carles, Santos, Daniel Wagner C. L., Manzardo, Christian, Agüero, Fernando, Moreno, Asunción, Oppenheimer, Federico, Diekmann, Fritz, Medina‐Pestana, Jose O., Miro, Jose Maria, Alcaraz, A., Ambrosioni, J., Bodro, M., Blanco, J.L., Brunet, M., Garcia, F., Paredes, D., Esforzado, N., Marcos, M.A., Mallolas, J., Martinez, E., Mosquera, M.D., Musquera, M., Peri, L., Revuelta, I., Ricart, M.J., Soy, D., Torregrosa, J.V., Tuset, M.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.08.2017
• Subjects: Acquired immune deficiency syndrome; acute rejection; Adult; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Bacteria; Bacterial infections; Biopsy; Brazil; Calcineurin; Calcineurin Inhibitors - therapeutic use; Cohort analysis; Cohort Studies; Complications; Demographics; Demography; Developing countries; Drug Interactions; Female; Graft rejection; Graft Survival; Hepatitis; Hepatitis C; HIV; HIV infection; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - virology; Human immunodeficiency virus; Humans; Immunosuppression; Immunosuppressive Agents - therapeutic use; Infections; Ischemia; Kidney Function Tests; Kidney Transplantation; Kidney transplants; LDCs; Male; Middle Aged; patient survival; Patients; Regional differences; Rejection; Retrospective Studies; Spain; Survival; Transplantation; Transplants & implants; Treatment Outcome; Viruses; Brazil; Spain; regional differences; patient survival; acute rejection; antiretroviral therapy; kidney transplantation; Brazil; graft survival; HIV infection; Spain
• ISSN: 1398-2273; 1399-3062; 1399-3062
• DOI: 10.1111/tid.12724

Background In the developed world, kidney transplantation (KT) in patients with human immunodeficiency virus (HIV) infection is well established. Developing countries concentrate 90% of the people living with HIV, but their experience is underreported. Regional differences may affect outcomes. Objectives We compared the 3‐year outcomes of patients with HIV infection receiving a KT in two different countries, in terms of incomes and development. Methods This was an observational, retrospective, double‐center study, including all HIV‐infected patients >18 years old undergoing KT. Results Between 2005 and 2015, 54 KTs were performed (39 in a Brazilian center, and 15 in a Spanish center). Brazilians had less hepatitis C virus co‐infection (5% vs 27%, P=.024). Median cold ischemia time was higher in Brazil (25 vs 18 hours, P=.001). Biopsy‐proven acute rejection (AR) was higher in Brazil (33% vs 13%, P=.187), as were the number of AR episodes (22 vs 4, P=.063). Patient survival at 3 years was 91.3% in Brazil and 100% in Spain; P=.663. All three cases of death in Brazil were a result of bacterial infections within the first year post transplant. At 3 years, survival free from immunosuppressive changes was lower in Brazil (56% vs 90.9%, P=.036). Raltegravir‐based treatment to avoid interaction with calcineurin inhibitor was more prevalent in Spain (80% vs 3%; P<.001). HIV infection remained under control in all patients, with undetectable viral load and no opportunistic infections. Conclusion Important regional differences exist in the demographics and management of immunosuppression and antiretroviral therapy. These details may influence AR and infectious complications. Non‐AIDS infections leading to early mortality in Brazil deserve special attention.