Identification of Optimal Donor-Recipient Combinations Among Human Immunodeficiency Virus (HIV)-Positive Kidney Transplant Recipients.

Academic Article

Abstract

  • For some patient subgroups, human immunodeficiency virus (HIV) infection has been associated with worse outcomes after kidney transplantation (KT); potentially modifiable factors may be responsible. The study goal was to identify factors that predict a higher risk of graft loss among HIV-positive KT recipients compared with a similar transplant among HIV-negative recipients. In this study, 82 762 deceased donor KT recipients (HIV positive: 526; HIV negative: 82 236) reported to the Scientific Registry of Transplant Recipients (SRTR) (2001-2013) were studied by interaction term analysis. Compared to HIV-negative recipients, the hepatitis C virus (HCV) amplified risk 2.72-fold among HIV-positive KT recipients (adjusted hazard ratio [aHR]: 2.72, 95% confidence interval [CI]: 1.75-4.22, p < 0.001). Forty-three percent of the excess risk was attributable to the interaction between HIV and HCV (attributable proportion of risk due to the interaction [AP]: 0.43, 95% CI: 0.23-0.63, p = 0.02). Among HIV-positive recipients with more than three HLA mismatches (MMs), risk was amplified 1.80-fold compared to HIV-negative (aHR: 1.80, 95% CI: 1.31-2.47, p < 0.001); 42% of the excess risk was attributable to the interaction between HIV and more than three HLA MMs (AP: 0.42, 95% CI: 0.24-0.60, p = 0.01). High-HIV-risk (HIV-positive/HCV-positive HLAwith more than three MMs) recipients had a 3.86-fold increased risk compared to low-HIV-risk (HIV-positive/HCV-negative HLA with three or fewer MMs)) recipients (aHR: 3.86, 95% CI: 2.37-6.30, p < 0.001). Avoidance of more than three HLA MMs in HIV-positive KT recipients, particularly among coinfected patients, may mitigate the increased risk of graft loss associated with HIV infection.
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    Keywords

  • clinical research/practice, health services and outcomes research, immune deficiency, infection and infectious agents, infectious disease, kidney transplantation/nephrology, viral: hepatitis C, viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), Female, Follow-Up Studies, Glomerular Filtration Rate, Graft Rejection, Graft Survival, HIV Infections, HIV-1, Hepacivirus, Hepatitis C, Histocompatibility Testing, Humans, Kidney Failure, Chronic, Kidney Function Tests, Kidney Transplantation, Male, Middle Aged, Prognosis, Risk Factors
  • Digital Object Identifier (doi)

    Author List

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

  • 2377
  • End Page

  • 2383
  • Volume

  • 16
  • Issue

  • 8