Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients

Academic Article

Abstract

  • Excellent outcomes among HIV+ kidney transplant (KT) recipients have been reported by the NIH consortium, but it is unclear if experience with HIV+ KT is required to achieve these outcomes. We studied associations between experience measures and outcomes in 499 HIV+ recipients (SRTR data 2004-2011). Experience measures examined included: (1) center-level participation in the NIH consortium; (2) KT experiential learning curve; and (3) transplant era (2004-2007 vs. 2008-2011). There was no difference in outcomes among centers early in their experience (first 5 HIV+KT) compared to centers having performed >6 HIV+ KT (GS adjusted hazard ratio [aHR]: 1.05, 95% CI: 0.68-1.61, p=0.82; PS aHR: 0.93; 95% CI: 0.56-1.53, p=0.76), and participation in the NIH-study was not associated with any better outcomes (GS aHR: 1.08, 95% CI: 0.71-1.65, p=0.71; PS aHR: 1.13; 95% CI: 0.68-1.89, p=0.63). Transplant era was strongly associated with outcomes; HIV+ KTs performed in 2008-2011 had 38% lower risk of graft loss (aHR: 0.62; 95% CI: 0.42-0.92, p=0.02) and 41% lower risk of death (aHR: 0.59; 95% CI: 0.39-0.90, p=0.01) than that in 2004-2007. Outcomes after HIV+ KT have improved over time, but center-level experience or consortium participation is not necessary to achieve excellent outcomes, supporting continued expansion of HIV+ KT in the US.
  • Keywords

  • (SRTR), Clinical research/practice, Graft survival, Health services and outcomes research, Infection and infectious agents, Infectious disease, Kidney (allograft) function/dysfunction, Kidney transplantation/nephrology, Patient survival, Scientific Registry for Transplant Recipients, Viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
  • Digital Object Identifier (doi)

    Author List

  • Locke JE; Reed RD; Mehta SG; Durand C; Mannon RB; Maclennan P; Shelton B; Martin MY; Qu H; Shewchuk R