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Living-related donor renal transplantation in HIV+ recipients using alemtuzumab preconditioning and steroid-free tacrolimus monotherapy: A single canter preliminary experience

Tan, HP and Kaczorowski, DJ and Basu, A and Khan, A and McCauley, J and Marcos, A and Fung, JJ and Starzl, TE and Shapiro, R (2004) Living-related donor renal transplantation in HIV+ recipients using alemtuzumab preconditioning and steroid-free tacrolimus monotherapy: A single canter preliminary experience. Transplantation, 78 (11). 1683 - 1688. ISSN 0041-1337

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Abstract

Background. End-stage renal disease (ESRD) is an increasing problem in patients infected with the human immunodeficiency virus (HIV). The use of highly active antiretroviral therapy (HAART) has decreased the morbidity associated with HIV and has prompted renewed interest in renal transplantation. Methods. We performed four cases of deceased donor renal transplantation in HIV+ recipients and three cases where laparoscopic live donor nephrectomy (LLDN) was utilized to obtain the kidney for transplantation into living-related HIV+ recipients. In the four deceased donor cases, conventional tacrolimus-based immunosuppression, without antibody induction was used. In the three living-related cases, the immunosuppressive regimen was based on two principles: recipient pretreatment and minimal posttransplant immunosuppression. Alemtuzumab 30 mg (Campath 1-H) was used for preconditioning followed by low-dose tacrolimus monotherapy. Results. Of the four deceased donor cases, one patient continues to have good graft function, and another is not yet on dialysis but has significant graft dysfunction. Rejection was observed in three patients (75%). Infectious complications occurred in one patient (25%), all non-acquired immunodeficiency syndrome (AIDs) defining. In the three living-related cases, all had good graft function, and none have experienced acute rejection. HIV viral loads remain undetectable. CD4 counts are slowly recovering. No infectious or surgical complications occurred. There were no deaths in either group. Conclusions. These data suggest that living-related donor renal transplantation with steroid-free tacrolimus monotherapy in a "tolerogenic" regimen can be efficacious. However, long-term follow-up is needed to confirm this observation.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Tan, HP
Kaczorowski, DJ
Basu, A
Khan, A
McCauley, J
Marcos, A
Fung, JJ
Starzl, TEtes11@pitt.eduTES11
Shapiro, R
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 15 December 2004
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 78
Number: 11
Page Range: 1683 - 1688
DOI or Unique Handle: 10.1097/01.tp.0000145880.38548.0d
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062121169, Starzl CV No. 2204
Date Deposited: 08 Apr 2010 17:37
Last Modified: 18 Oct 2017 02:55
URI: http://d-scholarship.pitt.edu/id/eprint/5590

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