Introduction: HIV positive status is a well-known risk factor for acute rejection (AR) in kidney transplant recipients (KTR). In the United States, the majority of HIV positive KTR are of black race which is also a well-established risk factor for AR. Recent studies suggest that anti-thymocyte globulin (ATG)[mdash]a potent lymphocyte depleting agent[mdash]may be well-tolerated in HIV positive KTR and superior to other induction immunosuppression strategies in reducing AR. However over-immunosuppression with ATG is still a major concern in this high risk population.

Hypothesis: ATG induction reduces the risk of AR in black HIV positive KTR, but not in non-black HIV positive KTR.

Methods: In the Scientific Registry of Transplant Recipients, 807 HIV positive adult solitary KTR were identified between years 2000-2014. These recipients were stratified by race (black v. non-black) and induction immunosuppression (ATG v. non-ATG). The primary outcome was 5-year AR incidence. Multivariate Cox models adjusted for potential confounders.

Results: Among all HIV positive KTR, 73% were of black race. In black recipients, a significant reduction in AR was seen with ATG compared to non-ATG induction strategies (19% v. 30%, p=0.02; Fig. 1). But in non-black recipients, no AR benefit was observed with ATG (12% v. 15%, p=0.67; Fig. 2). Multivariate Cox models confirmed that ATG was associated with less AR in black recipients (H.R.=0.63; 95% C.I.=0.41-0.97; p=0.037), but not with non-black recipients.

Conclusion: Our study suggests that ATG induction immunosuppression reduces AR in black HIV positive KTR, but may not provide an additional benefit in non-black HIV positive KTR. When weighing immunosuppresion efficacy versus safety, recipient race may have important implications on the choice of induction immunosuppression in HIV positive KTR.

CITATION INFORMATION: Casey M, Aijaz T, Wen X, Rehman S, Santos A, Thomas E, Andreoni K, Womer K. Kidney Transplantation in HIV Patients: Effect of Race on the Choice of Anti-Thymocyte Globulin Induction Immunosuppression. Am J Transplant. 2016;16 (suppl 3).

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