Renal transplantation between HIV-positive donors and recipients justified

HIV infection was previously an absolute contraindication to renal transplantation. However, with the advent of highly active antiretroviral therapy (HAART), renal transplantation using HIV-negative donor kidneys has successfully been employed for HIV-infected patients with end-stage renal failure. In resource-limited countries, places on dialysis programmes are severely restricted; HIV-infected patients, like many others with co-morbidity, are often denied treatment. Kidneys (and other organs) from HIV-infected deceased donors are discarded. The transplantation of HIV-positive donor kidneys to HIV-infected recipients is now a viable alternative to chronic dialysis or transplantation of HIV-negative donor kidneys. This significantly increases the pool of donor kidneys to the advantage of HIV-positive and -negative patients. Arguments are presented that led to our initiation of renal transplantation from HIV-positive deceased donors to HIV-positive recipients at Groote Schuur Hospital, Cape Town

Rapidly progressive post-transplant lymphoproliferative disease following withdrawal of sirolimus

Sirolimus, a potent inhibitor of B- and T-cell activation. is a commonly used immunosuppressant after renal transplantation. Withdrawal of sirolimus from the immunosuppression regimen may reduce B-cell surveillance. We present a case of rapidly progressive central nervous system (CNS) polymorphic Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disorder following the withdrawal of sirolimus

Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective.

INTRODUCTION:Access to dialysis and transplantation in the developing world remains limited. Therefore, optimising renal allograft survival is essential. This study aimed to evaluate clinical outcomes and identify poor prognostic factors in the renal transplant programme at Groote Schuur Hospital [GSH], Cape Town.     . METHOD:Data were collected on all patients who underwent a kidney transplant at GSH from 1st July 2010 to the 30 June 2015. Analyses were performed to assess baseline characteristics, graft and patient survival, as well as predictors of poor outcome.    . RESULTS:198 patients were transplanted. The mean age was 38 +/- 10.5 years, 127 (64.1%) were male, and 86 (43.4%) were of African ethnicity. Deceased donor organs were used for 130 (66.7%) patients and living donors for 65 (33.3%). There were > 5 HLA mismatches in 58.9% of transplants. Sepsis was the commonest cause of death and delayed graft function [DGF] occurred in 41 (21.4%) recipients. Patient survival was 90.4% at 1 year and 83.1% at 5 years. Graft survival was 89.4% at 1 year and 80.0% at 5 years. DGF (HR 2.83 (1.12-7.19), p value = 0.028) and recipient age > 40 years (HR 3.12 (1.26-7.77), p value = 0.014) were predictors of death. CONCLUSION:Despite the high infectious burden, stratified immunosuppression and limited tissue typing this study reports encouraging results from a resource constrained transplant programme in South Africa. Renal transplantation is critical to improve access to treatment of end stage kidney disease where access to dialysis is limited

Characteristics of Patients assessed by the renal replacement committee before and after the use of Prioritization Criteria (N = 564).

<p>Characteristics of Patients assessed by the renal replacement committee before and after the use of Prioritization Criteria (N = 564).</p

Baseline demographics of Blacks vs. Non-Blacks⁺ among new patients presented to the renal assessment committee in Groote Schuur from 2008–2012.

<p>Baseline demographics of Blacks vs. Non-Blacks<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0176041#t002fn003" target="_blank">⁺</a> among new patients presented to the renal assessment committee in Groote Schuur from 2008–2012.</p

Socio-demographic characteristics of new patients presented to the renal assessment committee in Groote Schuur from 2008–2012.

<p>Socio-demographic characteristics of new patients presented to the renal assessment committee in Groote Schuur from 2008–2012.</p

Clinical characteristics of new patients presented for the renal replacement program in Groote Schuur hospital from 2008–2012.

<p>Clinical characteristics of new patients presented for the renal replacement program in Groote Schuur hospital from 2008–2012.</p

Comparison of Western Cape Guidelines (2010) with the Department of Health Guidelines (2009).

<p>Comparison of Western Cape Guidelines (2010) with the Department of Health Guidelines (2009).</p