Epidemiological and Immunological Characteristics of HIV-Infected Patients on the Cadaveric Kidney Donor Waiting List at the Johannesburg Renal Transplant Program

摘要

HIV infection was previously considered an exclusion criterion for renal dialysis and transplant. Recent research has prompted policy changes, allowing for transplantation in this subgroup of patients. Theoretical risks with transplantation include the immune dysregulation associated with post-transplantation immunosuppression and immune activation with possible organ rejection. Assessments for eligibility to renal transplantation rely on a point system, which allocates points based on a patient's age, previous transplants, and time on the waiting list as well as panel reactive antibodies among other parameters. This study aimed at quantifying and defining the clinically relevant characteristics of HIV-infected patients on the cadaveric donor waiting list on the Johannesburg renal transplant program. Clinical records for patients on the transplant list from November 2016 to October 2017 were accessed from existing databases and clinical records. A total of 248 patients were analyzed during the study period. There were a total of 215 HIV-uninfected patients, and 33 HIV-infected patients were on the waiting list. The median age for patients at listing was 39 years (interquartile range 29-47). There were no significant differences in the median age of listing between the HIV-infected and HIV-uninfected groups (p = .7). Hypertension was the most common cause of renal failure in both study groups. The study did not show any significant differences in age or immunological characteristics between the HIV-infected and HIV-uninfected groups. This suggests that for immunological risk stratification purposes, these two groups of patients could be considered equivalent. A possible explanation for this could be that antiretroviral therapy has a significant role in mitigating the effect of the virus on the immune system. Further studies looking at a larger study population are required to corroborate these findings. These data do provide reassurance that HIV-infected patients are suitable candidates for transplantation.