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HIV-Infected Kidney Graft Recipients Managed With an Early Corticosteroid Withdrawal Protocol: Clinical Outcomes and Messenger RNA Profiles

Muthukumar, Thangamani1,2,7; Afaneh, Cheguevara3; Ding, Ruchuang1; Tsapepas, Demetra4; Lubetzky, Michelle1; Jacobs, Samantha5; Lee, John1; Sharma, Vijay1,6; Lee, Jun1,2,6; Dadhania, Darshana1,2; Hartono, Choli1,2,6; McDermott, Jennifer4; Aull, Meredith3; Leeser, David3; Kapur, Sandip3; Serur, David1,2,6; Suthanthiran, Manikkam1,2

doi: 10.1097/TP.0b013e31827ac322
Clinical and Translational Research

Background: The outcome of HIV-infected kidney transplant recipients managed with an early corticosteroid withdrawal protocol is not known.

Methods: Eleven consecutive HIV-infected patients with undetectable plasma HIV RNA and more than 200/mm3 CD4+ T cells underwent deceased-donor (n=8) or living-donor (n=3) kidney transplantation at our center. All were managed with an early corticosteroid withdrawal protocol; 9 of 11 received antithymocyte globulin and 2 received basiliximab induction. We analyzed patient and graft outcomes, acute rejection rate, HIV progression, BKV replication, infections, and urinary cell mRNA profiles.

Results: The median (range) follow-up was 44.5 (26–73) months. The incidence of acute rejection was 9% at 1 year and the patient and allograft survival rates were 100% and 91%, respectively. Estimated glomerular filtration rate at 1 year (mean±SD) was 78±39 mL/min/1.73 m2. Plasma HIV RNA was undetectable at 24 months and none had BKV replication. Six of the 11 kidney recipients developed eight infections requiring hospitalization. Urinary cell levels of mRNA for complement components and complement regulatory proteins, cell lineage–specific proteins CD3, CD4, CD8, CTLA4, Foxp3, chemokine IP-10, cytotoxic perforin and granzyme B, and BKV VP1 mRNA were not different (P>0.05) between HIV-infected patients and HIV-negative recipients (n=22) with stable graft function and normal biopsy results.

Conclusion: An early steroid withdrawal regimen with antithymocyte globulin induction was associated with excellent graft and patient outcomes in HIV-infected recipients of kidney allografts. Their urinary cell mRNA profiles are indistinguishable from those of HIV-negative patients with stable graft function and normal biopsy results.

Supplemental digital content is available in the article.

1 Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, NY.

2 Department of Transplantation Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, NY.

3 Division of Transplant Surgery, Department of Surgery, New York Presbyterian-Weill Cornell Medical Center, New York, NY.

4 Department of Pharmacy, New York Presbyterian Hospital, New York, NY.

5 Division of Infectious Diseases, Department of Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, NY.

6 The Rogosin Institute, New York, NY.

7 Address correspondence to: Thangamani Muthukumar, M.D., Division of Nephrology and Hypertension, Department of Transplantation Medicine, New York Presbyterian-Weill Cornell Medical Center, 525 East 68th Street, Box 3, New York, NY 10065

Supported in part by the National Institutes of Health awards K08-DK087824 (T.M.) and T32 HL08382401 (Todd Evans (C.A.)], by the Empire Clinical Research Investigator Program New York State Award (M.L.), by National Institutes of Health award MERRIT 2R37-AI051652 and the Qatar National Research Foundation NPRP 08-503-3-11 (M.S.), and by a Clinical and Translational Science Center award ULI RR 024996 to Weill Medical College.

The authors declare no conflicts of interest.

Parts of the information reported in this article were presented as abstracts at the American Society of Nephrology Kidney Week 2010 and the American Transplant Congress 2011.

E-mail: muthu@med.cornell.edu

T.M. and C.A. contributed equally to this work.

T.M. and C.A. participated in the research design, writing of the article, performance of the research, and data analysis. R.D. participated in the research design, data analysis, and new reagents or analytic tools. D.T. participated in the research design, performance of research, and data analysis. M.L., S.J., and D.D. participated in the research design and data analysis. J.L., V.S., C.H., J.M., M.A., D.L., S.K., and D.S. participated in the research design. M.S. participated in the research design, writing of the article, and data analysis.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Received 8 August 2012. Revision requested 15 October 2012.

Accepted 22 October 2012.

© 2013 by Lippincott Williams & Wilkins