Objective: To evaluate effects of geographical factors on demography, clinical management and evolution of two cohorts of HIV-infected KT recipients.

Methods: Observational, retrospective cohort study including all consecutive HIV-infected patients >18y submitted to a KT in two referral centers

Results: There were 54 KT included for analysis: 39 performed in Hospital do Rim, São Paulo, Brazil (G1) and 15 in Hospital Clinic, Barcelona, Spain (G2). All patients had undetectable viral load at KT. Mean follow-up was 3±2year in G1 and 5±3 in G2 (p=0.005). There were no differences in recipient age, gender (G1 42±7y, 67%male vs. G2 47±7, 47%) or CKD etiology. G1 had more non-Caucasian recipients (54% vs. 0%,p=0.001) and less HCV co-infection (5% vs. 27%,p=0.024). Living KT was more prevalent in G2 (27%) vs. G1 (0%,p=0.004). Median cold ischemia time was higher in G1 (25±6 hours vs. 18±5,p=0.001). Differences in immunosuppressive therapy were: thymoglobulin induction (G1 28% vs. G2 40%, p=0.11) and TAC-MMF-P (G1 59% vs. G2 80%,p=0.005). The antiretroviral regimens (ART) more used in G1 were protease inhibitor-based (47%) and NNRTI-based (49%,p<0.05). Raltegravir-based treatment was used in 3% of G1 and 27% of G2 (p=0.007). G1 had higher delayed graft function and acute renal rejection (BPAR) (61% and 33%,respectively) vs. G2 (40%, p<0.05, and 13%,p=0.187). Death-censored graft survival at 1 and 5-y were similar (G1 94% and 84%;G2 93% and 86%,p=NS). Patient survival at 5-years was similar between G1 (91%) and G2 (93%,p=NS). Three cases of death occurred in G1 and one in G2, all in the first year post transplant and due to bacterial/fungal infection. There were no differences in renal function (5yr. creatinine [mg/L]:G1 1.8±0.6 vs. G2 1.4±0.6,p=NS). Changes to ART were more prevalent in G2 (80%) than G1 (33%,p<0.05). No opportunistic infections were observed after KT, and plasma HIV viral load was suppressed in all patients.

Conclusion: There is a significant influence of country characteristics in the patient demography and clinical, immunosuppressant and ART management of HIV-infected KT patients. Nevertheless, this geographical effect did not have a negative impact neither on renal allograft survival nor on patient survival.

CITATION INFORMATION: Cristelli M, Cofán F, Tedesco-Silva H, Trullas J, Santos D, Manzardo C, Aguero F, Moreno A, Oppenheimer F, Dieckmann F, Miro J, Medina-Pestana J. Influence of Country-Associated Geographical Variables in the Ouctomes of Kidney Transplantation in Patients with HIV-Infection. Am J Transplant. 2016;16 (suppl 3).

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