Review - Reviewer's Assessment

1. Short summary / abstract
HIV disease is currently much better controlled, since the advent of the Highly active anti-retroviral therapy (HAART), with this context as backround, this document provides guidance for kidney transplant in patients with HIV disease.
It refers to widespread experiences which suggest outcomes comparable to non HIV recipients.
It highlights that UK transplant guidelines whilst previously contraindicating HIV, have now changed accordingly.
The document advocates live donation as opposed to caadaveric.
It emphasises that these guidelines are produced while still on a learning curve, and could possibly change with experience.
The guidance is set out as :-
Key recommendations,
Audit standards,
Indications for transplant,
Pre-transplant assessment and vaccination,
Immunosuppressant protocols,
Monitoring of allograft function,
Psychological support


2. What question is the document addressing?
Should patients with HIV disease, who develop ESRD receive a transplant? and what guidlines should be followed according to present experiences ?

3. Type of study
Review of evidence with resultant guidance production.

4. Methods valid & appropriate?
Yes

Comments:
This document provides foundation guidance.

5. Results / recommendations reliable?
The level of evidence is cited as being based on good quality trials, observational studies/case studies, and expert opinion. The guidance is written on behalf of the British HIV association, reviewed and endorced by the British Transplantation Society's standards committee,

6. Any major problems and biases?
none apparent.

7. Any other important / relevant studies which confirm or contradict?
My review confirmed that the guidlines are based on international concurrence of experiences.
An updated print of these guidelines is available in the journal of HIV Medicine 7 (3), 133-139, doi;10.1111/j.1468-1293.2006.00367.x
The updated version is similar except for exclusion criteria, which now specify persistent infections or infections with resistent bacteria and fungi eg. Empyema, MRSA, and VRE.
In addition check :-
EBPG(European exper group on renal transplant). Evaluation, selection and preparation of the potential transplant recipient. Nephrol Dial Transplant 2000;15(suppl 7):3-38
Stock PG. Roland, ME. Carlson, LL. KIdney and liver transplantation in human immunodeficiency virus- infected patients: a pilot safety and efficacy study. Transplantation 2003: 76:370-375.
Roland, ME. Adey,D. Carlson, LL. Kidney and liver transplantation in HIV - infected patients; case presentations and review. AIDS patient care STDS 2003; 17: 501-507.
University of California and National Institute of Allergy and Infectious Disease protocol version 3.0 Solid Organ transplantation in HIV: multi-site study.


8. Keywords
Kidney transplant in HIV Inclusion and exclusion criteria immunosuppressent protocols.



Reviewer's Details:

Name:Nora Gill
Post:SSN/CCU/Royal Marsden
Affiliations
(Society / Organisation / Advisory Committee):


*** Note: These are the views of a professional expert rather than an official statement from his or her society, organisation or advisory committee.






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