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Patient W. A. M, 43 years old, social name L. A. M, with Chronic Kidney Disease (CKD) undergoing conventional hemodialysis for eleven years, with the probable underlying cause of CKD being nephropathy secondary to the Human Immunodeficiency Virus (HIV). Previous use of hormonal therapy for gender transition. Alongside CKD, the patient presented with osteoporosis, well-controlled hypertension, and anemia of chronic kidney disease. Kidney transplantation was performed in March 2023 at the Hospital das Clínicas of the Federal University of Minas Gerais (HC-UFMG). At the time of the procedure, the patient had undetectable HIV viral load and appropriate CD4+ T-cell count with the use of antiretroviral therapy (ART). Immunologically, both donor and recipient had identical HLA-DR, with the recipient having a PRA class I of 0% and class II of 68%, without the presence of DSA. The infectious risk between donor and recipient was considered low. Induction therapy was performed with thymoglobulin and intravenous methylprednisolone. Post-transplant immunosuppression consisted of tacrolimus and mycophenolate sodium. The cold ischemia time (CIT) of the graft was 9 hours and 30 minutes. As assessed in the current literature, fewer than twenty studies were found on the topic of transplantation in transgender patients, all of which were conducted abroad, possibly reflecting the exclusion experienced by this population in healthcare settings.
The patient's medical record was analyzed during pre-transplant consultations using the IAG digital platform provided by HC-UFMG. The hospital's AGHUx system was used to verify the periods of hospitalization and post-transplantation. Additionally, the topic was compared with the limited literary evidence on the case through research on educational platforms such as UpToDate and PebMed.
The patient was discharged after eighteen days, and the hospitalization period was uneventful. Currently, she is being monitored in the post-transplant outpatient clinic of the Hospital das Clínicas, showing adequate diuresis, ideal values of nitrogenous waste and electrolytes, with recent creatinine levels progressively declining and now at 2.76. Tacrolimus levels are being adjusted according to serum levels.
Kidney transplantation in transgender patients, especially those living with HIV, has limited data in both international and national literature. Given the social marginalization and limited access to healthcare services faced by this population, and considering that, with exceptions in immunosuppression management, kidney transplantation is indicated and radically improves the quality of life, reduces mortality, and fully integrates them into the public healthcare system. Abstract presented in poster format at the 2023 São Paulo Nephrology Congress in Brazil.