Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis
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AIDS Research and Therapy Open Access
RESEARCH
Kidney transplant outcomes in HIV‑positive patients: a systematic review and meta‑analysis Xin Zheng1,2, Lian Gong1,2, Wenrui Xue3, Song Zeng1,2, Yue Xu1,2, Yu Zhang3 and Xiaopeng Hu1,2*
Abstract Background: Kidney transplantation is now a viable alternative to dialysis in HIV-positive patients who achieve good immunovirological control with the currently available antiretroviral therapy regimens. This systematic review and meta-analysis investigate the published evidence of outcome and risk of kidney transplantation in HIV-positive patients following the PRISMA guidelines. Methods: Searches of PubMed, the Cochrane Library and EMBASE identified 27 cohort studies and 1670 case series evaluating the survival of HIV-positive kidney transplant patients published between July 2003 and May 2018. The regimens for induction, maintenance therapy and highly active antiretroviral therapy, acute rejection, patient and graft survival, CD4 count and infectious complications were recorded. We evaluated the patient survival and graft survival at 1 and 3 years respectively, acute rejection rate and also other infectious complications by using a randomeffects analysis. Results: At 1 year, patient survival was 0.97 (95% CI 0.95; 0.98), graft survival was 0.91 (95% CI 0.88; 0.94), acute rejection was 0.33 (95% CI 0.28; 0.38), and infectious complications was 0.41 (95% CI 0.34; 0.50), and at 3 years, patient survival was 0.94 (95% CI 0.90; 0.97) and graft survival was 0.81 (95% CI 0.74; 0.87). Conclusions: With careful selection and evaluation, kidney transplantation can be performed with good outcomes in HIV-positive patients. Background Traditionally, human immunodeficiency virus (HIV)positive patients (HIV+) has not been considered to be good candidates for solid-organ transplantation for the poor prognosis of HIV patients. However, with the introduction of antiretroviral combination therapy (cART), the survival of HIV+ patients have been great improved. While the frequency of Acquired Immune Deficiency Syndrome (AIDS)-related events has consequently decreased, mortality due to organ failure has become a significant concern. The initial attempts at kidney transplantation (KT) in HIV+ patients led to poor outcomes, but better results occurred with the availability of highly active antiretroviral therapy (HAART) [1, 2]. *Correspondence: [email protected] 2 Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti Nanlu, Chaoyang District, Beijing, China Full list of author information is available at the end of the article
In this scenario, KT started to be proposed as a treatment even as “standard-of-care” for end-stage renal disease (ESRD) in selected HIV+ patients [3]. A multicentre study in the USA found that the survival rates for HIV+ recipients fall between those reported for older KT recipients and for all recipients in the American national database [4]. Despite these encouraging results, many issues still need to be addressed. Among the mor
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