Kidney transplantation in HIV-positive adults: the UK experience

Int J STD AIDS. 2014 Jan;25(1):57-66. doi: 10.1177/0956462413493266. Epub 2013 Jul 19.


HIV-positive patients are at increased risk of end-stage kidney disease (ESKD). Kidney transplantation (KT) is an established treatment modality for ESKD in the general population. Recent data have confirmed the feasibility of kidney transplantation in HIV-positive patients, and kidney transplantation is increasingly offered to ESKD patients with well-controlled HIV infection. We report clinical outcomes in a national cohort study of kidney transplantation in HIV-positive patients. In all, 35 HIV-positive KT recipients who had undergone KT up to December 2010 (66% male, 74% black ethnicity) were identified; the median CD4 cell count was 366, all had undetectable HIV RNA levels at kidney transplantation, and 44% received a kidney from a live donor. Patient survival at 1 and 3 years was 91.3%, and graft survival 91.3% and 84.7%, respectively. At one-year post-kidney transplantation, the cumulative incidence of acute rejection was 48%, and the median (IQR) eGFR was 64 (46, 78) mL/min/1.73 m(2). Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of kidney transplantation in HIV-positive patients. The high rates of acute rejection suggest that the optimal immune suppression strategy in this population remains to be refined.

Keywords: AIDS; HIV; HIV-associated nephropathy; HIVAN; antiretroviral therapy; calcineurin inhibitor; dialysis; end stage kidney disease; kidney; renal failure; transplantation.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Female
  • Glomerular Filtration Rate
  • Graft Rejection / epidemiology
  • Graft Survival
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / immunology
  • Humans
  • Immunosuppression Therapy*
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Treatment Outcome
  • United Kingdom / epidemiology