Increased Mortality and Graft Loss With Kidney Retransplantation Among Human Immunodeficiency Virus (HIV)-Infected Recipients.

Academic Article

Abstract

  • Excellent outcomes have been demonstrated in primary human immunodeficiency virus (HIV)-positive (HIV+) kidney transplant recipients, but a subset will lose their graft and seek retransplantation (re-KT). To date, no study has examined outcomes among HIV+ re-KT recipients. We studied risk for death and graft loss among 4149 (22 HIV+ vs. 4127 HIV-negative [HIV-]) adult re-KT recipients reported to the Scientific Registry of Transplant Recipients (SRTR) (2004-2013). Compared to HIV- re-KT recipients, HIV+ re-KT recipients were more commonly African American (63.6% vs. 26.7%, p < 0.001), infected with hepatitis C (31.8% vs. 5.0%, p < 0.001) and had longer median time on dialysis (4.8 years vs. 2.1 years, p = 0.02). There were no significant differences in length of time between the primary and re-KT events by HIV status (1.5 years vs. 1.4 years, p = 0.52). HIV+ re-KT recipients experienced a 3.11-fold increased risk of death (adjusted hazard ratio [aHR]: 3.11, 95% confidence interval [CI]: 1.82-5.34, p < 0.001) and a 1.96-fold increased risk of graft loss (aHR: 1.96, 95% CI: 1.14-3.36, p = 0.01) compared to HIV- re-KT recipients. Re-KT among HIV+ recipients was associated with increased risk for mortality and graft loss. Future research is needed to determine if a survival benefit is achieved with re-KT in this vulnerable population.
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    Keywords

  • clinical research/practice, graft survival, infection and infectious agents, kidney transplantation/nephrology, patient survival, viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), Adult, Female, Follow-Up Studies, Glomerular Filtration Rate, Graft Rejection, Graft Survival, HIV Infections, HIV-1, Humans, Kidney Failure, Chronic, Kidney Function Tests, Kidney Transplantation, Male, Middle Aged, Postoperative Complications, Prognosis, Reoperation, Risk Factors, Transplant Recipients
  • Digital Object Identifier (doi)

    Author List

  • Shelton BA; Mehta S; Sawinski D; Reed RD; MacLennan PA; Gustafson S; Segev DL; Locke JE
  • Start Page

  • 173
  • End Page

  • 179
  • Volume

  • 17
  • Issue

  • 1