Can a patient with HIV be considered for kidney transplantation?
The National Institutes of Health have sponsored a multicenter trial to evaluate the efficacy of transplantation in patients with HIV.
The prerequisite for transplantation includes the use of cART therapy with a CD4 count >200 and an undetectable viral load. There is experience with the use of both liver and kidney transplants in patients with HIV.
The data show acceptable graft and patient survival with a higher risk of rejection, making transplantation a viable option in select patients with HIV. The pharmacologic interaction of cART and immunosuppressive therapy is challenging (as discussed previously) because of the effect of PIs on inhibiting the hepatic P450 enzyme system, thereby reducing the clearance of CNI and the risk of NRTIs, especially tenofovir, on potentiating calcineurin nephrotoxicity.
More recent studies have advocated for the use of HIV-positive donors for HIV-positive recipients—a concept that would significantly increase the donor pool for these patients.
