Renal transplantation in HIV-infected patients: 2010 update
2011; Elsevier BV; Volume: 79; Issue: 8 Linguagem: Inglês
10.1038/ki.2010.545
ISSN1523-1755
AutoresJoan Carles Trullàs, Frederic Cofán, Montserrat Tuset, M.J. Ricart, Merçè Brunet, Carlos Cervera, Christian Manzardo, María López-Diéguez, Federico Oppenheimer, Asunción Moreno, Josep M. Campistol, José M. Miró,
Tópico(s)Pneumocystis jirovecii pneumonia detection and treatment
ResumoThe prognosis of human immunodeficiency virus (HIV) infection has improved in recent years with the introduction of antiretroviral treatment. While the frequency of AIDS-defining events has decreased as a cause of death, mortality from non-AIDS-related events including end-stage renal diseases has increased. The etiology of chronic kidney disease is multifactorial: immune-mediated glomerulonephritis, HIV-associated nephropathy, thrombotic microangiopathies, and so on. HIV infection is no longer a contraindication to transplantation and is becoming standard therapy in most developed countries. The HIV criteria used to select patients for renal transplantation are similar in Europe and North America. Current criteria state that prior opportunistic infections are not a strict exclusion criterion, but patients must have a CD4+ count above 200 cells/mm3 and a HIV-1 RNA viral load suppressible with treatment. In recent years, more than 200 renal transplants have been performed in HIV-infected patients worldwide, and mid-term patient and graft survival rates have been similar to that of HIV-negative patients. The main issues in post-transplant period are pharmacokinetic interactions between antiretrovirals and immunosuppressants, a high rate of acute rejection, the management of hepatitis C virus coinfection, and the high cardiovascular risk after transplantation. More studies are needed to determine the most appropriate antiretroviral and immunosuppressive regimens and the long-term outcome of HIV infection and kidney graft. The prognosis of human immunodeficiency virus (HIV) infection has improved in recent years with the introduction of antiretroviral treatment. While the frequency of AIDS-defining events has decreased as a cause of death, mortality from non-AIDS-related events including end-stage renal diseases has increased. The etiology of chronic kidney disease is multifactorial: immune-mediated glomerulonephritis, HIV-associated nephropathy, thrombotic microangiopathies, and so on. HIV infection is no longer a contraindication to transplantation and is becoming standard therapy in most developed countries. The HIV criteria used to select patients for renal transplantation are similar in Europe and North America. Current criteria state that prior opportunistic infections are not a strict exclusion criterion, but patients must have a CD4+ count above 200 cells/mm3 and a HIV-1 RNA viral load suppressible with treatment. In recent years, more than 200 renal transplants have been performed in HIV-infected patients worldwide, and mid-term patient and graft survival rates have been similar to that of HIV-negative patients. The main issues in post-transplant period are pharmacokinetic interactions between antiretrovirals and immunosuppressants, a high rate of acute rejection, the management of hepatitis C virus coinfection, and the high cardiovascular risk after transplantation. More studies are needed to determine the most appropriate antiretroviral and immunosuppressive regimens and the long-term outcome of HIV infection and kidney graft. A few years ago, human immunodeficiency virus (HIV) infection was an absolute contraindication for solid organ transplantation. Concerns that post-transplant immunosuppression could result in accelerated HIV disease and increased risk for opportunistic infections meant that HIV-infected patients were not candidates for transplantation. Since the introduction of combined antiretroviral treatment (cART) in 1996, the natural history of HIV-infected patients has changed dramatically. Although AIDS-defining events have decreased steadily as a cause of death, there has been an increase in mortality from non-AIDS-related infections and late-stage organ diseases.1.Mocroft A. Brettle R. Kirk O. et al.Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study.AIDS. 2002; 16: 1663-1671Crossref PubMed Scopus (219) Google Scholar The first experiences for solid organ transplantation in HIV-infected patients were liver transplants in patients with hepatitis C virus (HCV) coinfection and hepatic cirrhosis.2.Miro J.M. Aguero F. Laguno M. et al.Liver transplantation in HIV/hepatitis co-infection.J HIV Ther. 2007; 12: 24-35PubMed Google Scholar In the case of end-stage renal disease (ESRD), renal replacement therapies (hemodialysis and peritoneal dialysis) are an alternative to renal transplantation. This is one of the reasons why renal transplantation was not initially considered a therapeutic option for HIV-infected patients with ESRD. However, at present, renal transplantation is a valid option in adequately selected HIV-infected patients with ESRD under dialysis or pre-emptively before starting dialysis.3.Landin L. Rodriguez-Perez J.C. Garcia-Bello M.A. et al.Kidney transplants in HIV-positive recipients under HAART. A comprehensive review and meta-analysis of 12 series.Nephrol Dial Transplant. 2010; 25: 3106-3115Crossref PubMed Scopus (22) Google Scholar We present the state of the art of renal transplantation in HIV-infected patients, focusing on clinical aspects, therapeutic strategies (immunosuppressive and antiretroviral treatments), ethical issues, comorbidity, and challenges that have to be faced in the coming years. Nephropathy is a common finding in patients with HIV infection and can present as acute or chronic kidney disease. Acute renal failure can be produced by the toxic effects of antiretroviral therapy (for example, tenofovir, indinavir) or nephrotoxic antimicrobial agents used in the treatment of opportunistic infections (for example, aminoglycosides, amphotericin, foscarnet, trimethoprim-sulfamethoxazole, acyclovir).4.Daugas E. Rougier J.P. Hill G. HAART-related nephropathies in HIV-infected patients.Kidney Int. 2005; 67: 393-403Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar, 5.Röling J. Schmid H. Fischereder M. et al.HIV-associated renal diseases and highly active antiretroviral therapy-induced nephropathy.Clin Infect Dis. 2006; 42: 1488-1495Crossref PubMed Scopus (114) Google Scholar The etiology of kidney disease is multifactorial: immune-mediated glomerulonephritis, HIV-associated nephropathy (HIVAN), drug-induced renal disease, nonreversible acute renal failure, or thrombotic microangiopathy. Moreover, long-term survival and an increase in cART-induced metabolic alterations will possibly cause an increase in diabetes and hypertensive renal diseases.5.Röling J. Schmid H. Fischereder M. et al.HIV-associated renal diseases and highly active antiretroviral therapy-induced nephropathy.Clin Infect Dis. 2006; 42: 1488-1495Crossref PubMed Scopus (114) Google Scholar Classic HIVAN presents histologically as collapsing focal segmental glomerulosclerosis and clinically as severe proteinuria, renal failure, and rapid progression to ESRD. It is the most common cause of ESRD in untreated HIV-infected black individuals who develop renal disease. It primarily occurs in patients of African descent, suggesting a genetic predisposition to the disease. Risk factors for its development include a CD4+ T-cell count 40000–51990152,6580.12Italy13.Barbiano di Belgiojoso G. Trezzi M. Scorza D. et al.HIV infection in dialysis centers in Italy: a nationwide multicenter study.J Nephrol. 1998; 11: 249-254PubMed Google Scholar199021,5000.11199527,0000.13France14.Poignet J.L. Desassis J.F. Chanton N. et al.Prevalence of HIV infection in dialysis patients: results of a national multicenter study.Nephrologie. 1999; 20: 159-163PubMed Google Scholar, 15.Vigneau C. Guiard-Schmid J.B. Tourret J. et al.The clinical characteristics of HIV-infected patients receiving dialysis in France between 1997 and 2002.Kidney Int. 2005; 67: 1509-1514Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar199722,7070.36200227,5770.67Spain16.Barril G. Trullás J.C. González-Parra E. et al.Prevalence of HIV-1-infection in dialysis units in Spain and potential candidates for renal transplantation: results of a Spanish survey.Enferm Infecc Microbiol Clin. 2005; 23: 335-339Crossref PubMed Google Scholar, 17.Trullàs J.C. Barril G. Cofan F. et al.Prevalence and clinical characteristics of HIV-1-infected patients receiving dialysis in Spain: results of a Spanish survey in 2006.AIDS Res Hum Retroviruses. 2008; 24: 1229-1235Crossref PubMed Scopus (18) Google Scholar200449621.15200614,8760.54Egypt18.Hassan N.F. el Ghorab N.M. Abdel Rehim M.S. et al.HIV infection in renal dialysis patients in Egypt.AIDS. 1994; 8: 853Crossref PubMed Scopus (23) Google Scholar199150001.64Japan19.Morikawa K. Kuroda M. Tofuku Y. et al.Prevalence of ATLV and HIV among hemodialysis patients in Japan.Nephron. 1988; 50: 77-78Crossref PubMed Google Scholar198613140Brazil20.Falcao H.A. Rebelo M. Anti-HIV antibodies in population of 132 patients in hemodialysis (Abstract). Xth International Congress of Nephrology, London1987Google Scholar198613214Abbreviations: HIV, human immunodeficiency virus; ND, no data available. Open table in a new tab Abbreviations: HIV, human immunodeficiency virus; ND, no data available. In Europe,11.Rao T.K.S. Acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV), and dialysis.in: Andreucci V.E. Fine L.G. International Yearbook of Nephrology 1991. Kluwer Academic, Boston1990: 199-218Google Scholar, 12.Geerlings W. Tufveson G. Brunner F.P. et al.Combined report on regular dialysis and transplantation in Europe, XXI, 1990.Nephrol Dial Transplant. 1991; 6: 5-29Google Scholar, 13.Barbiano di Belgiojoso G. Trezzi M. Scorza D. et al.HIV infection in dialysis centers in Italy: a nationwide multicenter study.J Nephrol. 1998; 11: 249-254PubMed Google Scholar, 14.Poignet J.L. Desassis J.F. Chanton N. et al.Prevalence of HIV infection in dialysis patients: results of a national multicenter study.Nephrologie. 1999; 20: 159-163PubMed Google Scholar, 15.Vigneau C. Guiard-Schmid J.B. Tourret J. et al.The clinical characteristics of HIV-infected patients receiving dialysis in France between 1997 and 2002.Kidney Int. 2005; 67: 1509-1514Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 16.Barril G. Trullás J.C. González-Parra E. et al.Prevalence of HIV-1-infection in dialysis units in Spain and potential candidates for renal transplantation: results of a Spanish survey.Enferm Infecc Microbiol Clin. 2005; 23: 335-339Crossref PubMed Google Scholar, 17.Trullàs J.C. Barril G. Cofan F. et al.Prevalence and clinical characteristics of HIV-1-infected patients receiving dialysis in Spain: results of a Spanish survey in 2006.AIDS Res Hum Retroviruses. 2008; 24: 1229-1235Crossref PubMed Scopus (18) Google Scholar the overall prevalence of HIV infection in dialysis units was 0–5% in 1980.11.Rao T.K.S. Acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV), and dialysis.in: Andreucci V.E. Fine L.G. International Yearbook of Nephrology 1991. Kluwer Academic, Boston1990: 199-218Google Scholar In the early 1990s, the European Renal Association-Dialysis and Transplant Association created a European registry including 152,658 patients under dialysis; the prevalence of HIV infection was 0.12%.12.Geerlings W. Tufveson G. Brunner F.P. et al.Combined report on regular dialysis and transplantation in Europe, XXI, 1990.Nephrol Dial Transplant. 1991; 6: 5-29Google Scholar In the cART era, information on prevalence in European countries is scarce, with the exception of small isolated studies from France14.Poignet J.L. Desassis J.F. Chanton N. et al.Prevalence of HIV infection in dialysis patients: results of a national multicenter study.Nephrologie. 1999; 20: 159-163PubMed Google Scholar, 15.Vigneau C. Guiard-Schmid J.B. Tourret J. et al.The clinical characteristics of HIV-infected patients receiving dialysis in France between 1997 and 2002.Kidney Int. 2005; 67: 1509-1514Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar and Spain.16.Barril G. Trullás J.C. González-Parra E. et al.Prevalence of HIV-1-infection in dialysis units in Spain and potential candidates for renal transplantation: results of a Spanish survey.Enferm Infecc Microbiol Clin. 2005; 23: 335-339Crossref PubMed Google Scholar, 17.Trullàs J.C. Barril G. Cofan F. et al.Prevalence and clinical characteristics of HIV-1-infected patients receiving dialysis in Spain: results of a Spanish survey in 2006.AIDS Res Hum Retroviruses. 2008; 24: 1229-1235Crossref PubMed Scopus (18) Google Scholar Other than three small-scale studies from the pre-cART era, there is little information from other world regions.18.Hassan N.F. el Ghorab N.M. Abdel Rehim M.S. et al.HIV infection in renal dialysis patients in Egypt.AIDS. 1994; 8: 853Crossref PubMed Scopus (23) Google Scholar, 19.Morikawa K. Kuroda M. Tofuku Y. et al.Prevalence of ATLV and HIV among hemodialysis patients in Japan.Nephron. 1988; 50: 77-78Crossref PubMed Google Scholar, 20.Falcao H.A. Rebelo M. Anti-HIV antibodies in population of 132 patients in hemodialysis (Abstract). Xth International Congress of Nephrology, London1987Google Scholar Survival of HIV-infected patients receiving dialysis has increased in the last two decades. Early studies from the 1980s reported that survival in patients with newly diagnosed AIDS and ESRD initiating hemodialysis was poor. Most of these patients had advanced HIV disease that was often accompanied by other opportunistic diseases.21.Ortiz C. Meneses R. Jaffe D. et al.Outcome of patients with human immunodeficiency virus on maintenance hemodialysis.Kidney Int. 1988; 34: 248-253Abstract Full Text PDF PubMed Google Scholar Outcome has improved dramatically, and the mortality rate is now approaching that for ESRD in the general population.22.Ahuja T.S. Grady J. Khan S. Changing trends in the survival of dialysis patients with human immunodeficiency virus in the United States.J Am Soc Nephrol. 2002; 13: 1889-1893Crossref PubMed Scopus (90) Google Scholar A recent study reported survival rates at 1, 3, and 5 years for HIV-infected patients on dialysis of 95.2, 71.7, and 62.7%, respectively; these were significantly lower than those of a matched HIV-negative cohort of dialysis patients.23.Trullàs J.C. Barril G. Cofan F. et al.Outcome and Prognostic Factors in HIV-1-Infected Dialysis Patients in Spain in the HAART Era: A Case-Control GESIDA/SEN Study. 17th CROI (Conference on Retroviruses and Opportunistic Infections, San Francisco2010Google Scholar Different factors have contributed to improved survival, the most relevant being the introduction of cART and treatment of opportunistic infections, as well as enhanced dialysis procedures. Some predictors of survival have been established in recent studies. The risk factors for mortality in the HIV-infected dialysis population are a lower CD4+ T-cell count, a higher viral load, the absence of cART, and a history of opportunistic infections.23.Trullàs J.C. Barril G. Cofan F. et al.Outcome and Prognostic Factors in HIV-1-Infected Dialysis Patients in Spain in the HAART Era: A Case-Control GESIDA/SEN Study. 17th CROI (Conference on Retroviruses and Opportunistic Infections, San Francisco2010Google Scholar, 24.Rodriguez R.A. Mendelson M. O'Hare A.M. et al.Determinants of survival among HIV-infected chronic dialysis patients.J Am Soc Nephrol. 2003; 14: 1307-1313Crossref PubMed Scopus (44) Google Scholar, 25.Tourret J. Tostivint I. du Montcel S.T. et al.Outcome and prognosis factors in HIV-infected hemodialysis patients.Clin J Am Soc Nephrol. 2006; 1: 1241-1247Crossref PubMed Scopus (34) Google Scholar In addition, underexposure or inadequate dose adjustment of cART in patients who have impaired renal function and/or are receiving dialysis may contribute to excess mortality among HIV-infected patients.26.Choi A.I. Rodriguez R.A. Bacchetti P. et al.Low rates of antiretroviral therapy among HIV-infected patients with chronic kidney disease.Clin Infect Dis. 2007; 45: 1633-1639Crossref PubMed Scopus (36) Google Scholar Despite this overall improvement in survival in recent years, a study including cohorts comprising black individuals reported poor survival in the pre-cART and in the cART era, as a consequence of inadequate HIV treatment in those patients (nearly half of patients initiating dialysis in the cART era were not receiving antiretroviral drugs).8.Atta M.G. Fine D.M. Kirk G.D. et al.Survival during renal replacement therapy among African Americans infected with HIV type 1 in urban Baltimore, Maryland.Clin Infect Dis. 2007; 45: 1625-1632Crossref PubMed Scopus (24) Google Scholar Most transplant groups from Europe and North America have been working toward harmonizing criteria for solid organ transplantation in HIV-infected patients.27., 28.Anonymous Solid organ transplantation in the HIV-infected patient.Am J Transplant. 2004; 4: 83-88PubMed Google Scholar, 29.Miro J.M. Torre-Cisneros J. Moreno A. et al.GESIDA/GESITRA-SEIMC, PNS and ONT consensus document on solid organ transplant (SOT) in HIV-infected patients in Spain (March, 2005).Enferm Infecc Microbiol Clin. 2005; 23: 353-362Crossref PubMed Scopus (68) Google Scholar, 30.Bhagani S. Sweny P. Brook G. Guidelines for kidney transplantation in patients with HIV disease.HIV Med. 2006; 7: 133-139Crossref PubMed Scopus (31) Google Scholar, 31.Grossi P. Tumietto F. Costigliola P. et al.Liver transplantation in HIV-infected individuals: results of the Italian national program.Transplantation. 2006; 82: 446Google Scholar These criteria are summarized in Table 2.Table 2HIV criteria for renal transplantation in Spain, Italy, the United Kingdom, and the United StatesSpain29.Miro J.M. Torre-Cisneros J. Moreno A. et al.GESIDA/GESITRA-SEIMC, PNS and ONT consensus document on solid organ transplant (SOT) in HIV-infected patients in Spain (March, 2005).Enferm Infecc Microbiol Clin. 2005; 23: 353-362Crossref PubMed Scopus (68) Google ScholarItaly31.Grossi P. Tumietto F. Costigliola P. et al.Liver transplantation in HIV-infected individuals: results of the Italian national program.Transplantation. 2006; 82: 446Google ScholarUnited Kingdom30.Bhagani S. Sweny P. Brook G. Guidelines for kidney transplantation in patients with HIV disease.HIV Med. 2006; 7: 133-139Crossref PubMed Scopus (31) Google ScholarUnited StatesaCooperative Clinical Trials in Adult Transplantation criteria. (ref. 28.Anonymous Solid organ transplantation in the HIV-infected patient.Am J Transplant. 2004; 4: 83-88PubMed Google Scholar)Opportunistic infectionsSomebPrevious tuberculosis, Pneumocystis jiroveci pneumonia (PCP), or esophageal candidiasis are not exclusion criteria.None in the previous yearNone after cART-induced immunologicalSomecPCP and esophageal candidiasis are not exclusion criteria.NeoplasmNoNoreconstitutionNoCD4+ T-cell count (cells/mm3)>200>200>200>200Plasma HIV-1 RNA viral load BDL on cARTYesYesYesYesAbbreviations: BDL, below detection level; cART, combined antiretroviral treatment; HIV, human immunodeficiency virus.a Cooperative Clinical Trials in Adult Transplantation criteria.b Previous tuberculosis, Pneumocystis jiroveci pneumonia (PCP), or esophageal candidiasis are not exclusion criteria.c PCP and esophageal candidiasis are not exclusion criteria. Open table in a new tab Abbreviations: BDL, below detection level; cART, combined antiretroviral treatment; HIV, human immunodeficiency virus. •Clinical criteria: Ideally, no patients should have had AIDS-defining diseases, as this may lead to a greater risk for reactivation. However, some opportunistic infections (tuberculosis, esophageal candidiasis, and Pneumocystis jiroveci pneumonia) have been withdrawn as exclusion criteria, because they can be treated effectively and prevented.•Immunological criteria: All groups have agreed that the CD4+ T-cell count should be >200 cells/mm3 for renal transplantation, because most opportunistic infections appear when the CD4+ T-cell count is below this cutoff.•Virological criteria: The ideal situation is one in which the patient tolerates cART before transplant with an undetectable HIV viral load in plasma by ultrasensitive techniques (<50 copies/ml). In some cases (for example, patients who remain viremic with antiretroviral medication), it is essential to carry out antiretroviral sensitivity testing to ascertain the real therapeutic options. Some patients do not have an indication for cART, as they are long-term non-progressors or do not fulfill the immunological or clinical criteria to start treatment and, therefore, have viremia that is detectable in plasma. In this setting, it is unknown whether and when (pre- or post-transplant) it would be beneficial to initiate cART, so that an undetectable viral load can be reached.•Other criteria: The candidate must have a favorable psychiatric evaluation. Patients who actively consume drugs or alcohol will be excluded. In Spain, a consumption-free period of 2 years is recommended for heroin and cocaine and 6 months for other drugs (for example, alcohol). Patients who are on stable methadone maintenance programs are not excluded. Finally, patients must show an appropriate degree of social stability to ensure adequate care in the post-transplant period. There is less information on the evaluation of HIV-infected patients for transplantation. The largest study performed to date retrospectively reviewed 309 potentially eligible HIV-infected patients who had been evaluated for renal transplantation. Only 20% were included on the list or underwent transplant compared with 73% in HIV-negative patients evaluated during the same period. The most common factors associated with failure to complete transplant evaluation are: CD4+ T-cell count and viral load data not provided at initial evaluation (35%), CD4+ T-cell count and viral load not meeting the eligibility criteria (21%), and other factors including black race (black HIV-infected patients seem less likely to complete the transplant evaluation, a pattern that has also been observed in the general transplant population32.Epstein A.M. Ayanian J.Z. Keogh J.H. et al.Racial disparities in access to renal transplantation–clinically appropriate or due to underuse or overuse?.N Engl J Med. 2000; 343: 1537-1544Crossref PubMed Scopus (362) Google Scholar) and a history of illicit drug use.33.Sawinski D. Wyatt C.M. Casagrande L. et al.Factors associated with failure to list HIV-positive kidney transplant candidates.Am J Transplant. 2009; 9: 1-5Crossref PubMed Google Scholar In Europe, recent data from the EuroSIDA cohort study evaluated this issue among 88 HIV-infected ESRD patients. Criteria related to poor control of HIV infection (low CD4+ T-cell count or detectable viral load) were reported in 30% of cases and the remaining two-thirds of patients were excluded, usually because of cardiovascular diseases or diabetes.9.Trullas J.C. Mocroft A. Cofan F. et al.Dialysis and renal transplantation in HIV-infected patients: a European survey.J Acquir Immune Defic Syndr. 2010; 55: 582-589Crossref PubMed Scopus (22) Google Scholar Between 1980 and 1990, a total of 39 HIV-infected kidney recipients (case reports and case series with a small number of patients) were documented (Table 3).34.Schwarz A. Offermann G. Keller F. et al.The effect of cyclosporine on the progression of human immunodeficiency virus type 1 infection transmitted by transplantation--data on four cases and review of the literature.Transplantation. 1993; 55: 95-103Crossref PubMed Google Scholar, 35.Trullás J.C. Miró J.M. Barril G. et al.Renal transplantation in patients with HIV infection.Enferm Infecc Microbiol Clin. 2005; 23: 363-374Crossref PubMed Google Scholar, 36.Feduska N.J. Perkins H.A. Melzer J. et al.Observations relating to the incidence of the acquired immune deficiency syndrome and other possibly associated conditions in a large population of renal transplant recipients.Transplant Proc. 1987; 19: 2161-2166PubMed Google Scholar, 37.Kumar P. Pearson J.E. Martín D.H. et al.Transmission of human immunodeficiency virus by transplantation of a renal allograft, with development of the acquired immunodeficiency syndrome.Ann Intern Med. 1987; 106: 244-245Crossref PubMed Google Scholar, 38.Imbasciati E. De Cristofaro V. Sama F. et al.Acquired immunodeficiency syndrome transmitted by transplanted kidney: clinical course during maintenance haemodialysis.Nephrol Dial Transplant. 1988; 3: 681-683Crossref PubMed Google Scholar, 39.Milgrom M. Esquenazi V. Fuller L. et al.Acquired immunodeficiency syndrome in a transplant patient.Transplant Proc. 1985; 17: 75Google Scholar, 40.Lang P. Buisson C. Foucher A. et al.Unusual immune deficiency syndrome associated with LAV/HTLV-III in a kidney transplant recipient.Transplant Proc. 1986; 18: 1400Google Scholar, 41.Poli F. Scalamonga M. Pizzi C. et al.HIV infection in cadaveric renal allograft recipients in the North Italy Transplant Program.Transplantation. 1989; 47: 724-725Crossref PubMed Google Scholar, 42.Erice A. Rhame F.S. Heussner R.C. et al.HIV infection in patients with solid-organ transplants: report of five cases and review.Rev Infect Dis. 1991; 13: 537-547Crossref PubMed Google Scholar, 43.Prompt C.A. Reis M.M. Grillo F.M. et al.Transmission of AIDS virus at renal transplantation.Lancet. 1985; 2: 672Abstract PubMed Scopus (42) Google Scholar, 44.L'age-Stehr J. Schwarz A. Offermann G. et al.HTLV-III infection in kidney transplant recipients.Lancet. 1985; 2: 1361-1362Abstract PubMed Scopus (45) Google Scholar, 45.Schwarz A. Hoffmann F. L'age-Stehr J. et al.Human immunodeficiency virus transmission by organ donation. Outcome in cornea and kidney recipients.Transplantation. 1987; 44: 21-24Crossref PubMed Google Scholar, 46.Margreiter R. Fuchs D. Hausen A. et al.HIV infection in renal allograft recipients.Lancet. 1986; 2: 398Abstract PubMed Scopus (12) Google Scholar, 47.Briner V. Zimmerli W. Cathomas G. et al.HIV infection caused by kidney transplant: case report and review of 18 published cases.Schweiz Med Wochenschr. 1989; 119: 1046-1052PubMed Google Scholar, 48.Ahuja T.S. Zingman B. Glicklich D. Long-term survival in an HIV
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