AI Article Synopsis
- Protease inhibitors (PIs) can complicate post-transplant care in HIV-infected renal transplant recipients due to interactions with calcineurin inhibitors, leading many to switch to non-PI regimens before surgery.
- A study analyzing 50 HIV-infected renal transplant patients found that those on PI-based regimens had lower rejection rates and better graft survival compared to those on non-PI regimens.
- Despite no significant differences in certain kidney injury metrics between groups, the findings indicate that PI regimens may provide adequate outcomes, warranting further research to define the best post-transplant treatment approaches.
Article Abstract
Background: Protease inhibitors (PI) pose a challenge post-transplant due to significant drug interactions with calcineurin inhibitors, prompting many clinicians to convert patients to non-interacting regimens prior to transplant. The purpose of this study was to examine the impact of PI-based regimens on graft outcomes in HIV-infected renal transplant recipients.
Methods: In this retrospective cohort study, 50 HIV-infected renal allograft recipients (27 receiving a PI regimen, 23 receiving a non-PI regimen) transplanted between 2003-2015 were analyzed.
Results: Cumulative rejection rates at 12 and 36 months were 41% and 54% in the PI group vs 52% and 86% in the non-PI group. At last follow-up, the overall risk of acute rejection in the PI group was 46% lower compared with the non-PI cohort (P = 0.12). Patients who received a PI-based regimen had significantly reduced graft failure rates (P = 0.027). There was no difference between groups in the degree of interstitial fibrosis/tubular atrophy, arteriolar hyalinosis, arterial sclerosis, or glomerular sclerosis on available biopsies, despite longer follow-up time in the PI group.
Conclusions: Our study suggests that PI-based antiretroviral therapy regimens are associated with improved graft survival and that patients can achieve adequate outcomes on a PI-based regimen when necessary. Due to study limitations, further studies are needed to determine the optimal immunosuppression/antiretroviral therapy regimen post-transplant.
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| http://dx.doi.org/10.1111/tid.12992 | DOI Listing |
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