3 years ago

Epidemiological and immunological characteristics of HIV-infected patients on the cadaveric kidney donor waiting list at the Johannesburg renal transplant program.

Bongane Steven Ngutshane, Anna Sparaco, Elizabeth Sarah Mayne
HIV infection was previously considered an exclusion criterion for renal dialysis and transplant. Recent research has prompted policy changes allowing for transplantation in this subgroup of patients. Theoretical risks with transplantation include the immune dysregulation associated with post-transplantation immunosuppression and immune activation with possible organ rejection. Assessments for eligibility to renal transplantation rely on a point system, which allocates points based on patient's age, previous transplants, and time on the waiting list as well as panel reactive antibodies (PRAs) amongst other parameters. Our aim with this current study was to define the clinically relevant epidemiological and immunological characteristics of HIV-infected patients with End Stage Renal Disease on the cadaveric donor of a high volume unit in Johannesburg, South Africa. Clinical records for patients on the transplant list from November 2016 to October 2017 were accessed from existing databases and clinical records. A total of 248 patients were analyzed during the study period. There were a total of 215 HIV-uninfected patients and 33 HIV infected patients were on the waiting list. The median age for patients at listing was 39 years (IQR 29-47). There were no significant differences in the median age of listing between HIV-infected and the HIV-uninfected groups (p=0.7). Hypertension was the most common cause of renal failure in both study groups. The study did not any significant differences in age or immunological characteristics between the HIV infected and uninfected group. This suggests that for immunological risk stratification purposes, these two groups of patients could be considered equivalent. A possible explanation for this could be that Antiretroviral therapy (ART) has a significant role in mitigating the effect of the virus on the immune system. Further studies looking udy population are required to corroborate these findings. These data do provide reassurance, that HIV-infected patients are suitable candidates for transplantation.

Publisher URL: http://doi.org/10.1089/AID.2018.0193

DOI: 10.1089/AID.2018.0193

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