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Liver & Kidney Transplants in HIV: New Research at Intl Congress on
Transplantation Society
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Transplants in HIV Patients Should Proceed, But Drug Interactions Can Be
Concern, Concludes Research at International Congress of The Transplantation
Society
MIAMI, Aug. 29 /PRNewswire/ -- While historically surgeons have been
reluctant to transplant patients with the human immunodeficiency virus (HIV),
in recent years, some centers have begun to accept patients with well-
controlled HIV as candidates for liver or kidney transplantation. Based on
results of three studies from the United States and one from France, which
collectively reported on 34 kidney and 17 liver transplants in HIV-positive
patients, researchers conclude that organ transplantation should indeed be
considered a treatment option for such patients.
Reporting at the XIX International Congress of The Transplantation Society
being held at the Westin Diplomat Resort and Spa in Hollywood, Fla., the
researchers said that after more than one year of follow-up, outcomes in
patients with HIV are very similar to outcomes in transplant patients without
HIV, and importantly, the immunosuppressive drugs used to control organ
rejection seem to have little effect on HIV progression.
But, the researchers added, managing these anti-rejection drugs and the
anti-retroviral therapies for HIV presents quite a challenge.
Mindful that the drugs may interact with each other or be toxic, transplant
teams must achieve just the right balance between the two types of drugs.
Suppressing the immune system too much with high doses of the anti- rejection
drug may allow the HIV infection to worsen. Too low a dose, and the organ
may be rejected.
Surgeons are seeing more patients with HIV needing liver or kidney
transplants because the so-called highly active anti-retroviral therapies
(HAART) are allowing patients with HIV to live longer with fewer HIV-related
complications. Yet for HIV patients who also have liver disease, such as
hepatitis B or hepatitis C, longer life expectancy also may allow progression
of their chronic liver disease to end-stage liver failure. Some patients
with HIV are developing end-stage kidney failure as a result of their HIV
infection or from the anti-retroviral medications, some which can be toxic to
the kidney.
In Philadelphia, where between 2 and 5 percent of patients on kidney dialysis
have HIV, researchers at Hahnemann University Hospital performed 20 kidney
transplants. One patient studied lost his graft to vascular rejection
because a drug interaction with one of the medications in the HAART therapy
made it difficult to achieve therapeutic levels of the anti-rejection drugs.
According to Dr. Anil Kumar, more than one year after transplantation, 17
patients are alive and well and viral loads of HIV remain very low or
undetectable, just as they were before surgery.
Drug interactions between the anti-rejection drug tacrolimus and protease
inhibitors caused an acute rejection in one patient and toxic levels of
tacrolimus in another, according to results presented by Dr. Didier Samuel of
Paul Brousse Hospital in Villejuif, France. Six patients with HIV and
hepatitis C received liver transplants. One patient died from liver failure,
while the remaining five patients are alive more than a year following
transplantation with negligible levels of HIV viral load and a significant
improvement in quality of life.
The University of Pittsburgh examined the very issue of drug interactions and
drug toxicity in a study of seven liver and four kidney transplant patients
whose immunosuppression consisted of tacrolimus and steroids, and in one
patient, rapamycin was also used. Profound drug interactions were observed
in a liver transplant patient taking the anti-rejection drug tacrolimus and
HAART therapy that included a protease inhibitor, reported Dr. Ashok Jain
earlier this week. In contrast, regimens that included nucleoside reverse
transcriptase inhibitors or non-nucleoside reverse transcriptase inhibitors
produced less significant effects in the four kidney recipients and the other
six liver patients.
At the University of California, San Francisco, four liver and 10 kidney
transplants were performed in HIV-positive patients. HIV viral loads have
remained undetectable in all patients on anti-retroviral therapy. The only
death occurred in a 15-year-old child who underwent liver transplantation for
hepatitis C who died as a result of a rapid recurrence of the hepatitis
virus, said Dr. Peter Stock. Interestingly, patients on protease inhibitors
required 25 percent of the dose of the anti-rejection drug cyclosporine
compared to patients on non-nucleoside reverse transcriptase inhibitors.
There has been no evidence of significant HIV progression or any adverse
effect of the virus on organ function, the researchers reported.
Held every two years, the International Congress of The Transplantation
Society is recognized as the field's most important international scientific
meeting. More than 1,600 abstracts covering basic and clinical science are
being presented, and nearly 3,000 surgeons, physicians and researchers from
71 countries are in attendance. Co-chairs of the congress are Drs. Camillo
Ricordi of the Diabetes Research Institute at the University of Miami School
of Medicine and Domingo Casadei of the Instituto de Nefrologia in Buenos
Aires.
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