High frequency of rejections in HIV-positive recipients of kidney transplantation: a single center prospective trial

Transplantation. 2012 Nov 27;94(10):1020-4. doi: 10.1097/TP.0b013e31826c3947.


Background: This is a single institution report of the incidence of combined acute antibody-mediated rejection (ABMR) + acute cellular rejection (ACR) [mixed rejection] in HIV (+) kidney transplant recipients.

Methods: We prospectively enrolled 92 HIV (+) patients who received a kidney transplant between 2001 and 2009. There were three cohorts: no rejection [n=26], ACR [n=53], and mixed rejections (ABMR and ACR) [n=13]. Immunosuppression comprised of basiliximab, cyclosporine, sirolimus, and steroid minimization. Fisher exact tests for categorical variables, t test for continuous variables, and Kaplan-Meier estimates were used to describe events.

Results: Mixed rejections were seen in all 13 HIV (+) kidney transplant recipients (14%) with a median time to ABMR of 48 days. Acute cellular rejection occurred in 28% at 1 month and 55% at 12 months. eGFR was lower for recipients who experienced ABMR versus those experiencing ACR and those never experiencing rejection up to 3 years (14 ± 9.4 vs 19 ± 3.3 vs 29 ± 7.3 mL/min, respectively). Kaplan-Meier showed that graft survival up to 9 years was worse in recipients experiencing mixed rejection. Suboptimal donors with terminal creatinine greater than 2.5 mg/dL was associated with increased incidence of mixed rejections versus cellular rejections and no rejection (42% vs 17% vs. 8%, respectively).

Conclusions: Our single center study showed a relatively higher incidence of mixed rejection compared with that reported for non-HIV transplant recipients. A donor terminal serum creatinine greater than 2.5 mg/dL predicted mixed rejection, which was associated with poor outcomes. Donor selection and optimization of immunosuppression may be critical in these patients.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active
  • Cohort Studies
  • Creatinine / blood
  • Female
  • Graft Rejection / epidemiology*
  • Graft Rejection / immunology*
  • Graft Rejection / prevention & control
  • Graft Survival
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Kidney Transplantation / immunology*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Regression Analysis
  • Retrospective Studies
  • Tissue Donors


  • Immunosuppressive Agents
  • Creatinine