Kidney transplantation in HIV-positive patients treated with a steroid-free immunosuppressive regimen

Transpl Int. 2014 Oct;27(10):1050-9. doi: 10.1111/tri.12377. Epub 2014 Aug 20.


One of the main concerns associated with renal transplantation in HIV-infected patients is the high risk of acute rejection, which makes physicians reluctant to use steroid-free immunosuppressive therapy in this subset of patients. However, steroid therapy increases cardiovascular morbidity and mortality. The aim of this study was to define the efficacy of a steroid-sparing regimen in HIV-infected renal transplant recipients. Thirteen HIV-infected patients were consecutively transplanted. The induction therapy consisted of basiliximab and methylprednisolone for 5 days followed by a calcineurin inhibitor plus mycophenolate acid. The mean follow-up was 50 ± 22 months. Eight patients (61.5%) experienced acute rejection, and 75% of the first episodes occurred within 2 months after transplantation. The probability of first acute rejection was 58% after 1 year and 69% after 4 years. Seven of eight patients recovered or maintained their kidney function after antirejection therapy and steroid resumption. At the last follow-up, seven of 13 patients (54%) had resumed steroid therapy. The 4-year patient and graft survivals were 100% and 88.9%, respectively. The benefits of this steroid-free regimen in HIV-infected renal recipients must be reconsidered because of the high rate of acute rejection. New immunosuppressive steroid-free strategies should be identi-fied in this set of patients.

Keywords: HAART; HIV; induction therapy; kidney transplantation; rejection; steroid-free regimen.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Calcineurin Inhibitors / administration & dosage*
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • HIV Infections / complications
  • HIV Infections / diagnosis
  • HIV Infections / mortality
  • HIV Infections / surgery*
  • Humans
  • Immunosuppression Therapy / methods
  • Immunosuppressive Agents / administration & dosage*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / methods*
  • Male
  • Middle Aged
  • Mycophenolic Acid / administration & dosage*
  • Retrospective Studies
  • Risk Assessment
  • Steroids
  • Survival Analysis
  • Transplantation Immunology / physiology
  • Treatment Outcome
  • Young Adult


  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Steroids
  • Mycophenolic Acid