BACKGROUND Human immunodeficiency virus-associated nephropathy (HIVAN) has become the third leading cause of end-stage renal disease (ESRD) in African Americans, and is expected to grow exponentially. Highly active antiretroviral therapy (HAART) has significantly prolonged the survival of patients with HIV infection. Despite the growing number of HIV-positive dialysis patients with prolonged life expectancy, kidney transplantation with immunosuppression has been declined because it is considered a waste of scarce donor kidneys due to potential increases in morbidity and mortality. METHODS The institutional review board of Drexel University College of Medicine and Hahnemann University Hospital approved this prospective study. The aim was to find out safety and success of kidney transplantation, and the effect of immunosuppression on HIV infection. Forty HIV-positive dialysis patients received kidney transplantation between February 2001 and January 2004. Patient inclusion criteria were maintenance of HAART, plasma HIV-1 RNA of <400 copies/mL, absolute CD4 counts of 200 cells/muL or more. Immunosuppression was basiliximab induction and maintenance with cyclosporine, sirolimus, and steroids. HAART was continued post-transplant. Acute rejections were diagnosed by biopsy and treated with methylprednisolone. Surveillance biopsies were completed at 1, 6, 12, and 24 months, and evaluated for subclinical acute rejection, chronic allograft nephropathy, and HIVAN. RESULTS One- and 2-year actuarial patient survival was 85% and 82%, respectively, and graft survival was 75% and 71%, respectively. Plasma HIV-1 RNA remained undetectable, and CD4 counts remained in excess of 400 cells per muL with no evidence of AIDS for up to 2 years. CONCLUSION One- and 2-year graft survival is comparable to other high-risk populations receiving kidney transplantation. One- and 2-year patient survival is higher than HIV patients maintained on dialysis. Immunosuppression does not adversely affect HIV recipients maintained on HAART in the short term.

O325 CAD donors develop ARF during their terminal management due to a variety of causes that include anoxia, myoglobinuria, drug toxicity, dehydration, hypotension and shock. Many patients under normal circumstances recover from ARF. In spite of an acute shortage of kidneys for transplantation, kidneys with ARF are discarded. We hypothesized that CAD donor kidneys recover from ARF and provide adeqaute kidney function after transplantation.To test this hypothesis we transplanted 24 CAD kidneys from donors with ARF and compared the outcome with 24 matched recipients of kidneys from CAD donors with no ARF. All donors with ARF had normal kidney function on admission and a negative history for kidney disease, but developed oliguria and elevation of serum creatinine to 2mg per dl or more (range 2.3 to 9.0 mg%) during the hospitalization. One donor with serum creatinine of 9mg% required hemodialysis. Pretransplant kidney biopsies were completed in ARF kidneys and showed no chronic structural changes. ARF in donors was due to myoglobinuria, and prerenal causes. All recipients were given basiliximab induction and maintained on calcineurin inhibitor based immunosuppression. Protocol biopsies were completed at 1, 6 and 12 months.Table 1 shows the incidence of delayed graft function(DGF), acute rejection(AR), serum creatinine(SC), creatinine clearance(CCl) and patient and graft survival at 1 year between the 2 groups.[Table] Protocol biopsies showed a similar incidence of subclinical acute rejections and chronic allograft nephropathy. This data shows that cadaver kidneys with ARF have a significantly higher incidence of post transplant DGF than the control group. One year SC, CCL, incidence of AR and patient and graft survival are comparable to donor kidneys with no ARF. Though long term outcomes need to be studied, we recommend that cadaver kidneys with ARF from young donors with no history of kidney disease and a normal pretransplant biopsy be considered for transplantation to overcome the acute shortage of donor kidneys.Figurep=0.002