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

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

Author Cristelli, Marina P. Autor UNIFESP Google Scholar
Cofan, Federico Google Scholar
Tedesco-Silva, Helio Autor UNIFESP Google Scholar
Trullas, Joan Carles Google Scholar
Santos, Daniel Wagner C. L. Autor UNIFESP Google Scholar
Manzardo, Christian Google Scholar
Aguero, Fernando Google Scholar
Moreno, Asuncion Google Scholar
Oppenheimer, Federico Google Scholar
Diekmann, Fritz Google Scholar
Medina-Pestana, Jose O. Autor UNIFESP Google Scholar
Miro, Jose Maria Google Scholar
Abstract 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 >18years 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 18hours, 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 3years 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 3years, 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.
Keywords acute rejection
antiretroviral therapy
Brazil
graft survival
HIV infection
kidney transplantation
patient survival
regional differences
Spain
Language English
Sponsor Spanish Foundation for AIDS Research and Prevention (FIPSE), Madrid (Spain)
RETIC, Red de Sida
FEDER, Instituto de Salud Carlos III, Madrid, Spain
Instituto de Salud Carlos III, Ministerio de Economia y Competitividad, Madrid (Spain)
Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
'Departament de Salut de la Generalitat de Catalunya', Barcelona, Catalonia, Spain
Grant number FIPSE: 24-0858-09
RETIC: RD12/0017/0001
Instituto de Salud Carlos: INT15/00168
Date 2017
Published in Transplant Infectious Disease. Hoboken, v. 19, n. 4, p. -, 2017.
ISSN 1398-2273 (Sherpa/Romeo, impact factor)
Publisher Wiley
Extent -
Origin http://dx.doi.org/10.1111/tid.12724
Access rights Closed access
Type Article
Web of Science ID WOS:000407219800024
URI http://repositorio.unifesp.br/handle/11600/51467

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