KIDNEY TRANSPLANT REJECTION IN PEOPLE LIVING WITH HIV
DR LUCY MCMULLEN1,2, DOUGLAS DRAK2, GOPAL BASU3, P. TOBY COATES4, DAVID J. GOODMAN5, NICOLE ISBEL6, WAI H. LIM7, NIGEL D. TOUSSAINT8, GERMAINE WONG9, KATE WYBURN1,2, STEVE CHADBAN1,2, DAVID GRACEY1,2
1Renal Medicine Unit, Royal Prince Alfred Hospital, Sydney, Australia, 2Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia, 3Renal Medicine Unit, The Alfred, Melbourne, Australia, 4Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia, 5Department of Nephrology, St Vincent’s Hospital, Fitzroy, Australia, 6Department of Kidney Medicine, Princess Alexandra Hospital, Brisbane, Australia, 7Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia, 8Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia, 9Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
Aim: To describe characteristics and management of acute rejection in people living with kidney transplants and HIV in Australia.
Background: International data suggests that people living with HIV (PLWHIV) who undergo kidney transplantation experience higher rates of rejection. Management is complicated by antiretroviral therapy drug interactions, increased risk of allosensitisation, and enhancement of nonspecific alloimmunity.
Methods: ANZDATA was searched for PLWHIV aged >18 years who received a first kidney transplant and experienced episodes of acute rejection between January 2000 to December 2020 inclusive. Details on the time to first episode of acute rejection, histological findings, treatment and outcomes were reviewed.
Results: Thirty kidney transplants occurred in twenty-six PLWHIV in Australia between 2000 and 2020. Seven transplant recipients (27%) experienced biopsy-proven acute rejection during the median (IQR) allograft follow-up period of 5.9 (8.2) years. The median (IQR) time to first rejection was 30.5 (71.5) days post-transplant. Of these, one recipient had repeated rejection episodes across two grafts. Most of these were cellular (70%). Humoral rejection occurred in the third and fourth allografts in one in one individual, comprising 30% of total episodes. No episodes were mixed. The majority of episodes were histologically mild. Graft function returned to baseline in 50% of patients with cellular rejection. There was no graft loss due to acute rejection.
Conclusions: Acute rejection is common in PLWHIV with a kidney transplant. Most episodes occur early and respond to treatment.
Biography:
Dr Lucy McMullen is a final year renal advanced trainee at Royal Prince Alfred Hospital. She is passionate about equitable access to healthcare for vulnerable and marginalised populations.