Impact of Protease Inhibitor-Based Anti-Retroviral Therapy on Outcomes for HIV+ Kidney Transplant Recipients.

Academic Article

Abstract

  • Excellent outcomes have been demonstrated among select HIV-positive kidney transplant (KT) recipients with well-controlled infection, but to date, no national study has explored outcomes among HIV+ KT recipients by antiretroviral therapy (ART) regimen. Intercontinental Marketing Services (IMS) pharmacy fills (1/1/01-10/1/12) were linked with Scientific Registry of Transplant Recipients (SRTR) data. A total of 332 recipients with pre- and posttransplantation fills were characterized by ART at the time of transplantation as protease inhibitor (PI) or non-PI-based ART (88 PI vs. 244 non-PI). Cox proportional hazards models were adjusted for recipient and donor characteristics. Comparing recipients by ART regimen, there were no significant differences in age, race, or HCV status. Recipients on PI-based regimens were significantly more likely to have an Estimated Post Transplant Survival (EPTS) score of >20% (70.9% vs. 56.3%, p = 0.02) than those on non-PI regimens. On adjusted analyses, PI-based regimens were associated with a 1.8-fold increased risk of allograft loss (adjusted hazard ratio [aHR] 1.84, 95% confidence interval [CI] 1.22-2.77, p = 0.003), with the greatest risk observed in the first posttransplantation year (aHR 4.48, 95% CI 1.75-11.48, p = 0.002), and a 1.9-fold increased risk of death as compared to non-PI regimens (aHR 1.91, 95% CI 1.02-3.59, p = 0.05). These results suggest that whenever possible, recipients should be converted to a non-PI regimen prior to kidney transplantation.
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    Keywords

  • graft survival, health services and outcomes research, infection and infectious agents, kidney transplantation/nephrology, patient survival, viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), Adult, Anti-Retroviral Agents, 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, Protease Inhibitors, Risk Factors, Survival Rate, Transplant Recipients
  • Digital Object Identifier (doi)

    Author List

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

  • 3114
  • End Page

  • 3122
  • Volume

  • 17
  • Issue

  • 12