Deceased Donor Kidney Transplantation in a Human Immunodeficiency Virus–Infected Recipient: A Case Report

© 2019 Elsevier Inc.Human immunodeficiency virus (HIV)infection has traditionally been considered an absolute contraindication for transplantation because immunosuppression will accelerate the disease progression and increase mortality. New antiretroviral agents have given rise to new perspectives and transplantation practices. Now renal transplantation is the gold standard treatment for end-stage renal disease in HIV-infected patients, but increased rejection and toxicity rates and compliance with treatment are important issues. Therefore, patient selection and follow-up should be done carefully in this patient group. Here we present a 51-year-old, male, HIV-infected patient who was diagnosed with HIV at his routine serologic investigation at 2015. Highly active antiretroviral therapy was initiated. One haplotype-matched kidney transplantation from a deceased donor was performed on October 19, 2016. Induction therapy was not administered, and the immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisolone. After 26 months, serum creatinine was 1.1 mg/dL and proteinuria 0.1 g/day. There was no development of donor-specific antibodies. The patient's current HIV viral load remains undetectable (and had been the entire time post-transplantation)while his CD4+ T-cell count currently is 543/mm3

Effects of Rituximab on Atherosclerotic Biomarkers in Kidney Transplant Recipients

Introduction. Cardiovascular disease is the leading cause of mortality in kidney transplantrecipients. Rituximab is widely used in kidney transplantation for a variety of situations,and rituximab may inhibit some cytokines and antibodies that may play an active role in theatherosclerotic process. The aim of the study was to evaluate the efficacy of rituximab onatherosclerosis biomarkers in kidney transplant recipients.Methods. All patients, 18 years of age and older, who underwent kidney transplantationand received at least 1 dose of 375 mg/m2 rituximab were considered for participation inthis study. The primary study endpoint was the development of cardiovascular diseasesafter rituximab therapy. The secondary endpoint was the onset of cytomegalovirus (CMV)disease or biopsy-confirmed BK virus nephropathy. In addition, comparison ofatherosclerosis biomarkers was performed between study and control groups.Results. There were no cardiovascular events observed during follow up. Only 8 patientsin the study group suffered from CMV disease during follow up. Serum interleukin 10levels were significantly higher in the rituximab group compared with the control group,although antieoxidized low-density lipoprotein levels were lower in the rituximab groupcompared with the control group, though this did not achieve statistical significance.Discussion. Rituximab treatment may increase the risk of CMV reactivation anddecrease lymphocyte counts and interleukin 10 levels; however, significant decreases in allatherosclerotic-related biomarkers have not been shown in our study