Outcomes of kidney transplantation in HIV-infected recipients

Peter G. Stock, Burc Barin, Barbara Murphy, Douglas Hanto, Jorge Diego, Jimmy Light, Charles Davis, Emily Blumberg, David Simon, Aruna Subramanian, J. Michael Millis, G. Marshall Lyon, Kenneth Brayman, Doug Slakey, Ron Shapiro, Joseph Melancon, Jeffrey M. Jacobson, Valentina Stosor, Jean L. Olson, Donald M. StableinMichelle E. Roland

Research output: Contribution to journalArticle

305 Citations (Scopus)

Abstract

BACKGROUND: The outcomes of kidney transplantation and immunosuppression in people infected with human immunodeficiency virus (HIV) are incompletely understood. METHODS: We undertook a prospective, nonrandomized trial of kidney transplantation in HIV-infected candidates who had CD4+ T-cell counts of at least 200 per cubic millimeter and undetectable plasma HIV type 1 (HIV-1) RNA levels while being treated with a stable antiretroviral regimen. Post-transplantation management was provided in accordance with study protocols that defined prophylaxis against opportunistic infection, indications for biopsy, and acceptable approaches to immunosuppression, management of rejection, and antiretroviral therapy. RESULTS: Between November 2003 and June 2009, a total of 150 patients underwent kidney transplantation; survivors were followed for a median period of 1.7 years. Patient survival rates (±SD) at 1 year and 3 years were 94.6±2.0% and 88.2±3.8%, respectively, and the corresponding mean graft-survival rates were 90.4% and 73.7%. In general, these rates fall somewhere between those reported in the national database for older kidney-transplant recipients (≥65 years) and those reported for all kidney-transplant recipients. A multivariate proportional-hazards analysis showed that the risk of graft loss was increased among patients treated for rejection (hazard ratio, 2.8; 95% confidence interval [CI], 1.2 to 6.6; P = 0.02) and those receiving antithymocyte globulin induction therapy (hazard ratio, 2.5; 95% CI, 1.1 to 5.6; P = 0.03); living-donor transplants were protective (hazard ratio, 0.2; 95% CI, 0.04 to 0.8; P = 0.02). A higher-than-expected rejection rate was observed, with 1-year and 3-year estimates of 31% (95% CI, 24 to 40) and 41% (95% CI, 32 to 52), respectively. HIV infection remained well controlled, with stable CD4+ T-cell counts and few HIV-associated complications. CONCLUSIONS: In this cohort of carefully selected HIV-infected patients, both patient- and graftsurvival rates were high at 1 and 3 years, with no increases in complications associated with HIV infection. The unexpectedly high rejection rates are of serious concern and indicate the need for better immunotherapy. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00074386.)

Original languageEnglish
Pages (from-to)2004-2014
Number of pages11
JournalNew England Journal of Medicine
Volume363
Issue number21
DOIs
StatePublished - Nov 18 2010

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Kidney Transplantation
HIV
Confidence Intervals
Virus Diseases
CD4 Lymphocyte Count
Immunosuppression
Survival Rate
National Institute of Allergy and Infectious Diseases (U.S.)
T-Lymphocytes
Transplants
Kidney
Antilymphocyte Serum
Living Donors
Opportunistic Infections
Graft Survival
Immunotherapy
Survivors
HIV-1
Transplantation
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Stock, P. G., Barin, B., Murphy, B., Hanto, D., Diego, J., Light, J., ... Roland, M. E. (2010). Outcomes of kidney transplantation in HIV-infected recipients. New England Journal of Medicine, 363(21), 2004-2014. https://doi.org/10.1056/NEJMoa1001197

Outcomes of kidney transplantation in HIV-infected recipients. / Stock, Peter G.; Barin, Burc; Murphy, Barbara; Hanto, Douglas; Diego, Jorge; Light, Jimmy; Davis, Charles; Blumberg, Emily; Simon, David; Subramanian, Aruna; Millis, J. Michael; Lyon, G. Marshall; Brayman, Kenneth; Slakey, Doug; Shapiro, Ron; Melancon, Joseph; Jacobson, Jeffrey M.; Stosor, Valentina; Olson, Jean L.; Stablein, Donald M.; Roland, Michelle E.

In: New England Journal of Medicine, Vol. 363, No. 21, 18.11.2010, p. 2004-2014.

Research output: Contribution to journalArticle

Stock, PG, Barin, B, Murphy, B, Hanto, D, Diego, J, Light, J, Davis, C, Blumberg, E, Simon, D, Subramanian, A, Millis, JM, Lyon, GM, Brayman, K, Slakey, D, Shapiro, R, Melancon, J, Jacobson, JM, Stosor, V, Olson, JL, Stablein, DM & Roland, ME 2010, 'Outcomes of kidney transplantation in HIV-infected recipients', New England Journal of Medicine, vol. 363, no. 21, pp. 2004-2014. https://doi.org/10.1056/NEJMoa1001197
Stock PG, Barin B, Murphy B, Hanto D, Diego J, Light J et al. Outcomes of kidney transplantation in HIV-infected recipients. New England Journal of Medicine. 2010 Nov 18;363(21):2004-2014. https://doi.org/10.1056/NEJMoa1001197
Stock, Peter G. ; Barin, Burc ; Murphy, Barbara ; Hanto, Douglas ; Diego, Jorge ; Light, Jimmy ; Davis, Charles ; Blumberg, Emily ; Simon, David ; Subramanian, Aruna ; Millis, J. Michael ; Lyon, G. Marshall ; Brayman, Kenneth ; Slakey, Doug ; Shapiro, Ron ; Melancon, Joseph ; Jacobson, Jeffrey M. ; Stosor, Valentina ; Olson, Jean L. ; Stablein, Donald M. ; Roland, Michelle E. / Outcomes of kidney transplantation in HIV-infected recipients. In: New England Journal of Medicine. 2010 ; Vol. 363, No. 21. pp. 2004-2014.
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T1 - Outcomes of kidney transplantation in HIV-infected recipients

AU - Stock, Peter G.

AU - Barin, Burc

AU - Murphy, Barbara

AU - Hanto, Douglas

AU - Diego, Jorge

AU - Light, Jimmy

AU - Davis, Charles

AU - Blumberg, Emily

AU - Simon, David

AU - Subramanian, Aruna

AU - Millis, J. Michael

AU - Lyon, G. Marshall

AU - Brayman, Kenneth

AU - Slakey, Doug

AU - Shapiro, Ron

AU - Melancon, Joseph

AU - Jacobson, Jeffrey M.

AU - Stosor, Valentina

AU - Olson, Jean L.

AU - Stablein, Donald M.

AU - Roland, Michelle E.

PY - 2010/11/18

Y1 - 2010/11/18

N2 - BACKGROUND: The outcomes of kidney transplantation and immunosuppression in people infected with human immunodeficiency virus (HIV) are incompletely understood. METHODS: We undertook a prospective, nonrandomized trial of kidney transplantation in HIV-infected candidates who had CD4+ T-cell counts of at least 200 per cubic millimeter and undetectable plasma HIV type 1 (HIV-1) RNA levels while being treated with a stable antiretroviral regimen. Post-transplantation management was provided in accordance with study protocols that defined prophylaxis against opportunistic infection, indications for biopsy, and acceptable approaches to immunosuppression, management of rejection, and antiretroviral therapy. RESULTS: Between November 2003 and June 2009, a total of 150 patients underwent kidney transplantation; survivors were followed for a median period of 1.7 years. Patient survival rates (±SD) at 1 year and 3 years were 94.6±2.0% and 88.2±3.8%, respectively, and the corresponding mean graft-survival rates were 90.4% and 73.7%. In general, these rates fall somewhere between those reported in the national database for older kidney-transplant recipients (≥65 years) and those reported for all kidney-transplant recipients. A multivariate proportional-hazards analysis showed that the risk of graft loss was increased among patients treated for rejection (hazard ratio, 2.8; 95% confidence interval [CI], 1.2 to 6.6; P = 0.02) and those receiving antithymocyte globulin induction therapy (hazard ratio, 2.5; 95% CI, 1.1 to 5.6; P = 0.03); living-donor transplants were protective (hazard ratio, 0.2; 95% CI, 0.04 to 0.8; P = 0.02). A higher-than-expected rejection rate was observed, with 1-year and 3-year estimates of 31% (95% CI, 24 to 40) and 41% (95% CI, 32 to 52), respectively. HIV infection remained well controlled, with stable CD4+ T-cell counts and few HIV-associated complications. CONCLUSIONS: In this cohort of carefully selected HIV-infected patients, both patient- and graftsurvival rates were high at 1 and 3 years, with no increases in complications associated with HIV infection. The unexpectedly high rejection rates are of serious concern and indicate the need for better immunotherapy. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00074386.)

AB - BACKGROUND: The outcomes of kidney transplantation and immunosuppression in people infected with human immunodeficiency virus (HIV) are incompletely understood. METHODS: We undertook a prospective, nonrandomized trial of kidney transplantation in HIV-infected candidates who had CD4+ T-cell counts of at least 200 per cubic millimeter and undetectable plasma HIV type 1 (HIV-1) RNA levels while being treated with a stable antiretroviral regimen. Post-transplantation management was provided in accordance with study protocols that defined prophylaxis against opportunistic infection, indications for biopsy, and acceptable approaches to immunosuppression, management of rejection, and antiretroviral therapy. RESULTS: Between November 2003 and June 2009, a total of 150 patients underwent kidney transplantation; survivors were followed for a median period of 1.7 years. Patient survival rates (±SD) at 1 year and 3 years were 94.6±2.0% and 88.2±3.8%, respectively, and the corresponding mean graft-survival rates were 90.4% and 73.7%. In general, these rates fall somewhere between those reported in the national database for older kidney-transplant recipients (≥65 years) and those reported for all kidney-transplant recipients. A multivariate proportional-hazards analysis showed that the risk of graft loss was increased among patients treated for rejection (hazard ratio, 2.8; 95% confidence interval [CI], 1.2 to 6.6; P = 0.02) and those receiving antithymocyte globulin induction therapy (hazard ratio, 2.5; 95% CI, 1.1 to 5.6; P = 0.03); living-donor transplants were protective (hazard ratio, 0.2; 95% CI, 0.04 to 0.8; P = 0.02). A higher-than-expected rejection rate was observed, with 1-year and 3-year estimates of 31% (95% CI, 24 to 40) and 41% (95% CI, 32 to 52), respectively. HIV infection remained well controlled, with stable CD4+ T-cell counts and few HIV-associated complications. CONCLUSIONS: In this cohort of carefully selected HIV-infected patients, both patient- and graftsurvival rates were high at 1 and 3 years, with no increases in complications associated with HIV infection. The unexpectedly high rejection rates are of serious concern and indicate the need for better immunotherapy. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00074386.)

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