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HIV Patients Do Well After Kidney Transplants: Study
Date:11/18/2010

By Randy Dotinga
HealthDay Reporter

THURSDAY, Nov. 18 (HealthDay News) -- A large, new study provides more evidence that people infected with HIV, the virus that causes AIDS, do almost as well on the survival front as other patients when they undergo kidney transplants.

Up until the mid-1990s, physicians tended to avoid giving kidney transplants to HIV patients because of fear that AIDS would quickly kill them. Since then, new medications have greatly lengthened life spans for HIV patients, and surgeons routinely perform kidney transplants on them in some urban hospitals.

The study authors, led by Dr. Peter G. Stock, a professor of surgery at the University of California, San Francisco, examined the medical records of 150 HIV-infected patients who underwent kidney transplantation between 2003 and 2009. They report their findings in the Nov. 18 issue of the New England Journal of Medicine.

The researchers found that about 95 percent of the transplant patients lived for one year and about 88 percent lived for three years. Those survival rates fall between those for kidney transplant patients in general and those who are aged 65 and over.

"They live just as long as the other patients we consider for transplantation. They're essentially the same as the rest of our patients," said transplant specialist Dr. Silas P. Norman, an assistant professor of internal medicine at the University of Michigan. Norman was not part of the study team.

There was one troubling finding: the bodies of HIV patients were more likely to reject the kidneys than the bodies of other transplant patients. It's likely that surgeons will need to better tailor their procedures to help prevent organ rejection, said transplant surgeon Dr. Dorry Segev. This should happen as surgeons gain more experience with transplants in HIV patients, said Segev, an associate professor of surgery and epidemiology at Johns Hopkins Medical Institutions, who was familiar with the study findings.

Overall, Segev said, "treatment of HIV-infected patients undergoing kidney transplantation is clearly not straightforward, and this study has identified some challenges for the transplant community to address."

On the bright side, transplant procedures didn't appear to have much of an impact on the HIV infections in the patients.

In years past, Norman said, transplant surgeons worried about how the AIDS virus would interact with the medications given to transplant patients that are designed to dampen the immune system. The concern was that "these patients are now doing well, and you're going to give them medicine and undo all their benefits," he said.

But it turns out that transplantation drugs have the opposite effect and often suppress the AIDS virus, he said. This is because HIV revs up the immune system while the drugs turn it down, he explained.

Norman said he expects that the new findings will encourage more surgeons to perform kidney transplants on HIV patients, who are frequently surviving long enough to develop diseases that typically target older people.

"There are still a lot of people in the community, including transplant professionals, nephrologists and infectious disease professionals, who still don't appreciate that many of these patients are good prospects for transplantation," Norman said. "They don't appreciate how many procedures have been done to date, and how we're getting overall very good outcomes."

More information

For more about kidney transplants, try the U.S. National Library of Medicine.

SOURCES: Silas P. Norman, M.D., assistant professor, internal medicine, University of Michigan, Ann Arbor; Dorry Segev, M.D., Ph.D., associate professor, surgery and epidemiology, Johns Hopkins Medical Institutions, Baltimore; Nov. 18, 2010, New England Journal of Medicine


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