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Clin Transplant. 2019 Feb 17:e13499. doi: 10.1111/ctr.13499. [Epub ahead of print]

Solid Organ Transplantation in the HIV-Infected Patient: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.

Author information

1
Perelman School of Medicine, at the University of Pennsylvania, 3400 Spruce St., Ste E, 3 Silverstein, Philadelphia, PA, 19104.
2
Massachusetts General Hospital, 55 Fruit Street, GRB 005, Boston, MA, 02114.

Abstract

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the management of transplantation in HIV infected individuals. Transplantation has become the standard of care for patients with HIV and end stage kidney or liver disease. Although less data exist for thoracic organ and pancreas transplantation, it is likely that transplantation is also safe and effective for these recipients as well. Despite what is typically a transient decline in CD4+ T lymphocytes, HIV remains well-controlled and infection risks are similar to those of HIV uninfected transplant recipients. The availability of effective directly active antivirals for the treatment of Hepatitis C is likely to improve outcomes in HIV and HCV co-infected individuals, a population previously noted to have decreased survival. Drug interactions remain an important consideration and integrase inhibitor based regimens are preferred due to the absence of interactions with calcineurin and mTOR inhibitors. Additionally, despite the use of more potent immunosuppression, rejection rates exceed those found in HIV uninfected recipients. Ongoing research evaluating HIV positive organ donors may provide support for utilizing these donors for HIV positive patients in need of transplantation. This article is protected by copyright. All rights reserved.

PMID:
30773688
DOI:
10.1111/ctr.13499

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