Abstract
We report the first case of a simultaneous pancreas and renal transplantation, in Australia, in a 45 year old male with long standing human immunodeficiency virus infection, type 1 diabetes mellitus and diabetic nephropathy requiring haemodialysis. This patient experienced previous virological failure and subsequent resistance to most nucleoside and non-nucleoside reverse transcriptase inhibitors. However, using novel combinations of anti-retroviral agents, along with careful monitoring, successful outcomes were achieved during the peri and post transplantation period, with excellent pancreas and renal graft function at one year.
Highlights
Recent experiences suggest that transplantation can be safely conducted in patients with human immunodeficiency virus (HIV) infection
Most were on nucleoside reverse transcriptase inhibitor (NRTI) based regimes
The current case demonstrates that the presence of complex antiretroviral drug resistance patterns, requiring thoughtful antiretroviral treatment regimens, can be managed successfully to allow organ transplantation in HIV patients
Summary
Eight cases of simultaneous pancreas and kidney (SPK) transplantation in HIV patients with type 1 diabetes mellitus (T1DM) have been reported with good outcomes [1,2,3,4,5]. All patients were under the age of 50 years, with undetectable HIV RNA blood levels. At the time of transplantation, CD4 count was 518 cells/mL, HIV viral load was undetectable and CMV and EBV IgG were negative. Therapeutic drug monitoring (TDM) allowed gradual escalation of the CI dose, with the aim to achieve adequate, yet safe, immunosuppression to optimise graft survival. TDF was replaced by Tenofovir alafenamide combined with emtricitabine, a new agent with reduced nephrotoxicity His general health improved, despite several admissions with psoas collection and a splenic infarct.
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