Kidney transplantation in hiv-positive patients treated with a steroid-free immunosuppressive regimen.

INTRODUCTION: One of the main concerns associated with renal transplantation in HIV-infected patients is the high risk of acute rejection, which makes physicians reluctant to use steroid-free immunosuppressive therapy in this subset of patients. However, steroid therapy increases cardiovascular morbidity and mortality. The aim of this study was to define the efficacy of a steroid-sparing regimen in HIV-infected renal transplant recipients. METHODS: Thirteen HIV-infected patients were consecutively transplanted. The induction therapy consisted of basiliximab and methylprednisolone for five days followed by a calcineurin inhibitor plus mycophenolate acid. RESULTS: The mean follow-up was 50±22 months. Eight patients (61.5%) experienced acute rejection, and 75% of the first episodes occurred within two months after transplantation. The probability of first acute rejection was 58% after one year and 69% after four years. Seven of eight patients recovered or maintained their kidney function after anti-rejection therapy and steroid resumption. At the last follow-up, seven of 13 patients (54%) had resumed steroid therapy. The four-year patient and graft survivals were 100% and 88.9%, respectively. CONCLUSIONS: The benefits of a steroid-free regimen in HIV-infected renal recipients must be reconsidered because of the high rate of acute rejection. However, steroid withdrawal should always be considered in selected patients.