1022-LB
Aim This study aims to uncover the mechanisms that explain the unexpectedly high rate of clinical rejection of kidney transplant in HIV patients. If confirmed, the results will open a new era in the Art and Science of transplantation, and might have the potential to change the way we treat and prevent clinical rejection in allogenic kidney transplant in particular, and the whole transplant thinking about immunosuppression, in general. Methods From 2005 to 2010, seventeen patients with HIV disease have received a kidney transplant at the University of Miami Miller School of Medicine/Jackson Memorial Hospital. We have diagnosed eight patients with at least one episode of clinical rejection, a rate overwhelmingly higher than the standard 7% usually recorded for this institution. The immunosuppression regimen used for those patients is a steroid free protocol and is no different from the regimen utilized in the general population of our kidney transplants patients, including thymoglobuline / daclizumab boost as induction preventative treatment , and immunosuppresion maintenance regimen with tacrolimus, mycophenolate mofetil. We then analyze the immunologic profile of every patient included in the study, as well as the tacrolimus level pattern in those particular patients receiving antiretroviral medicine. Results All episodes of clinical rejection were successfully rescued with intravenous methylprednisolone, and addition of oral steroids in the maintenance regimen. Despite the inherently crippled immunologic status of HIV patients, they are still able to mount enough lymphocytic reaction in order to fight the transplanted kidney. We think that the swings in immunosuppresion level may be a strong factor in the occurrence of clinical rejection of the allograft.