Friday, April 23, 2010

HIV and the Kidney Transplant

What I learned at the NKF 2010 , some few points.

1. A large NIH sponsored study basically showed that the outcomes of large number of patients when compared to non hiv patients transplanted was no different.
2. The 3 year follow up showed no major difference in graft survival
3. HIV disease didn’t progress either, perhaps because they didn’t get induction therapy or they were carefully selected patients or there is data that almost all immunosuppresive drugs we use has anti HIV viral activity from cellcept to CNI to sirolimus
4. The major problems people run into these transplants are drug toxicities as anti retrovirals have significant effect on CNI levels and high doses of CNI and increased intervals are needed.
5. There is usually more rejection in these patients,perhaps because of point number 5, but also perhaps because they don’t get much induction

6. Some centers are using induction with thymo, but their acute bacterial infection rates are high. Ideally, a anti CD20 induction is a good choice.

A nice website to look at is:

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