Immunosuppression regimen and the risk of acute rejection in HIV-infected kidney transplant recipients.

Academic Article

Abstract

  • BACKGROUND: Kidney transplantation (KT) is the treatment for end-stage renal disease in appropriate HIV-positive individuals. However, acute rejection (AR) rates are over twice those of HIV-negative recipients. METHODS: To better understand optimal immunosuppression for HIV-positive KT recipients, we studied associations between immunosuppression regimen, AR at 1 year, and survival in 516 HIV-positive and 93,027 HIV-negative adult kidney-only recipients using Scientific Registry of Transplant Recipients data from 2003 to 2011. RESULTS: Consistent with previous reports, HIV-positive patients had twofold higher risk of AR (adjusted relative risk [aRR], 1.77; 95% confidence interval [CI], 1.45-2.2; P<0.001) than their HIV-negative counterparts as well as a higher risk of graft loss (adjusted hazard ratio, 1.51; 95% CI, 1.18-1.94; P=0.001), but these differences were not seen among patients receiving antithymocyte globulin (ATG) induction (aRR for AR, 1.16; 95% CI, 0.41-3.35, P=0.77; adjusted hazard ratio for graft loss, 1.54; 95% CI, 0.73-3.25; P=0.26). Furthermore, HIV-positive patients receiving ATG induction had a 2.6-fold lower risk of AR (aRR, 0.39; 95% CI, 0.18-0.87; P=0.02) than those receiving no antibody induction. Conversely, HIV-positive patients receiving sirolimus-based therapy had a 2.2-fold higher risk of AR (aRR, 2.15; 95% CI, 1.20-3.86; P=0.01) than those receiving calcineurin inhibitor-based regimens. CONCLUSION: These findings support a role for ATG induction, and caution against the use of sirolimus-based maintenance therapy, in HIV-positive individuals undergoing KT.
  • Published In

  • Transplantation  Journal
  • Keywords

  • Adolescent, Adult, Aged, Antilymphocyte Serum, Calcineurin Inhibitors, Female, Graft Rejection, Graft Survival, HIV Infections, Humans, Immunosuppression, Immunosuppressive Agents, Kidney Failure, Chronic, Kidney Transplantation, Male, Middle Aged, Multivariate Analysis, Registries, Risk, Sirolimus, Treatment Outcome, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Locke JE; James NT; Mannon RB; Mehta SG; Pappas PG; Baddley JW; Desai NM; Montgomery RA; Segev DL
  • Start Page

  • 446
  • End Page

  • 450
  • Volume

  • 97
  • Issue

  • 4