Thanks to improvements in antiretroviral therapy (ART) and improved immunosuppressive regimens, kidney transplantation in HIV patients has become a reality and viable option. HIV infection was a contraindication for organ transplantation in the past due to concern about the exacerbation of the disease secondary to immunosuppression. Presently, though, HIV patients can achieve favorable transplant outcomes equivalent to HIV-negative patients if appropriately managed.

Indications for Kidney Transplant in HIV Patients

HIV and end-stage renal disease (ESRD) patients require kidney transplantation from the following causes:-

HIV-associated nephropathy (HIVAN) – A common cause of ESRD in HIV-infected individuals.
Chronic kidney disease (CKD) due to ART toxicity – Certain antiretroviral drugs (e.g., tenofovir disoproxil fumarate) has the potential to be nephrotoxic.
Hypertension, diabetes, or other non-HIV-related kidney disorders.

Eligibility Criteria for Kidney Transplantation in HIV Patients

For an HIV-positive patient to be considered for kidney transplantation, they must meet the following criteria:-

Stable HIV Disease:

Undetectable viral load on ART.
CD4+ T-cell count ≥200 cells/mm³ (Some centers may accept ≥100 if there is no opportunistic infection).

No Active Opportunistic Infections:

History of opportunistic infections (e.g., TB, PCP pneumonia, CMV) should be well-controlled.
Active infections are a contraindication.

No Uncontrolled Malignancies:

HIV-related cancers (e.g., Kaposi’s sarcoma, lymphoma) should be in remission.

Good Adherence to Medications:

Strict adherence to ART and immunosuppressive therapy must be demonstrated by patients.

No Severe Liver Dysfunction:

Advanced liver-disease HIV patients (e.g., cirrhosis) would require combined kidney-liver transplant.

Challenges in HIV-Positive Kidney Transplant Recipients

Immunosuppressive Therapy & Drug Interactions

HIV patients are on long-term immunosuppressive drugs (e.g., tacrolimus, cyclosporine, steroids) with the potential to interact with ART.
Calcineurin inhibitors (CNIs) (e.g., tacrolimus, cyclosporine) are metabolized in the same hepatic pathway as ART and may require dose adjustment with caution.
MTOR inhibitors (sirolimus, everolimus) may be an option but require more studies in HIV patients.

Risk of Infections

Opportunistic infections (e.g., CMV, BK virus, TB) can occur secondary to immunosuppression.
Prophylactic drugs (e.g., trimethoprim-sulfamethoxazole for PCP, valganciclovir for CMV) are often needed.

Increased Risk of Rejection

Some studies suggest that HIV-positive recipients are at higher risk of acute rejection due to immune activation despite ART.

Long-Term Kidney Function

HIV-positive recipients have comparable graft survival rates to HIV-negative recipients but need careful monitoring.

Donor Options for HIV Patients

HIV-Negative Donors (Routine Practice)

HIV-positive recipients may receive kidneys from HIV-negative donors under strict control.

HIV-Positive Donors (HIV-to-HIV Transplants – HOPE Act)

The HOPE Act (HIV Organ Policy Equity Act) allows HIV-positive patients to receive organs from HIV-positive donors, increasing donor supply.
Research has shown that HIV-to-HIV kidney transplants work, though viral resistance or super infection is at higher risk.

Outcomes & Survival Rates

Graft survival - The 1-year and 5-year graft survival rates of HIV-positive recipients are similar to those of HIV-negative recipients.
Patient survival - Survival with proper ART and immunosuppression is the same as in non-HIV transplant recipients.
Rejection rates - Slightly higher risk, requiring careful monitoring.

Why choose Tender Palm Hospital Lucknow, India, for Kidney Transplantation in HIV Patients?

Every patient, either HIV or non-HIV, is entitled to access innovative, safe, and successful kidney transplants, and we at Tender Palm Super Specialty Hospital also agree. Our expert HIV Kidney Transplant Program is aimed at offering specialized care along with reducing complications to provide the best results to HIV-associated kidney disease patients.

Expertise in High-Risk Transplant

Our transplant team consists of experienced nephrologists, transplant surgeons, infectious diseases experts, and immunologists who specialize in kidney transplantation among HIV-positive individuals. Their combined proficiency ensures a safe and successful transplant process.

Comprehensive HIV Management & Care

We provide comprehensive pre- and post-transplant HIV care, such as:-

Careful antiretroviral therapy (ART) management to prevent drug interactions.
Ongoing immune system monitoring to reduce the risk of infections or rejection.
Routine viral load and CD4 count checks for best health before and after transplant.

Advanced Facilities & Technology

Advanced transplant ICUs and clean surgical facilities to minimize the risk of infection.
Advanced tissue matching and immunosuppression protocols customized for HIV-positive individuals.
Multidisciplinary care integrating nephrology, infectious disease, and transplant surgery teams.

Ethical & Safe Transplant Practices

Strict compliance with international transplant standards for HIV-positive individuals.
Strict screening and risk assessment procedures to safeguard patient safety.
Ethical, transparent, and law-compliant organ donation process.

High Success Rates & Long-Term Post-Transplant Care

High success rates in HIV-positive kidney transplants, which are closely monitored, are augmented with individualized post-transplant care.
Individualized immunosuppressive treatment for infection control versus rejection prevention.
Conscious follow-up programs for lifelong kidney health and HIV management.

Compassionate & Holistic Support

HIV patients and their families' pre-transplant and post-transplant counseling.
Special rehabilitation professionals and dietitians to aid in recovery and general well-being.
Confidentiality and individualized treatment to preserve patient dignity and comfort.

We offer advanced, caring, and specialized HIV-positive kidney transplant care at Tender Palm Super Specialty Hospital in Lucknow, India, to achieve successful and safe transplants. As an HIV-positive patient or the patient who needs a kidney transplant and you are your patient, you can trust our expert team to help you navigate through every process.