Introduction: Kidney transplant outcomes in HIV positive recipients are similar to HIV negative recipients. However, high published rates of acute rejection are a challenge. There is a paucity of data on the use of lymphocyte-depleting induction in HIV positive recipients. Here we describe outcomes in HIV positive recipients receiving Thymoglobulin induction.

Methods: We performed a retrospective review of all HIV positive patients who received kidney transplants at our center. HIV positive patients received Thymoglobulin induction (1.5 mg/kg x 3 doses) and Tacrolimus / MMF/ prednisone. Outcomes included patient survival, graft survival, and kidney function. HIV related outcomes included the development of opportunistic infections, CMV and BK virus infections, and CD4 counts. Rates of infections and rejections were compared to a control population of 260 transplant patients.

Results: 14 HIV positive patients received kidney transplants. One was an identical twin and received no induction. One developed PNF due to thrombosis of pediatric kidneys. The remaining 12 patients were included. 75% of patients were African American, 25% were Caucasian. 25% of transplants were from living donors. Average pre transplant CD4 was 586, with average recovery CD4 post transplant of 395. Ritonovir was not used post-transplant.

Compared a 2 year cohort of transplant patients at our center, survival, rejection and CMV infection were similar.

There were no deaths or non-CMV opportunistic infections. One year graft survival was 93% for the entire cohort, with the only loss being due to thrombosis (see above). CMV colitis occurred in one patient, and transient viremia in another. BK viruria occurred in 42% (5/12) (p<0.05 for comparison with controls), with BK viremia in 17% (2/12). No patients developed BK nephropathy. 1 patient developed acute cellular rejection (1a) treated with steroids.

Conclusion: Thymoglobulin induction is associated with low rates of rejection and excellent graft and patient survival in kidney transplantation. Prevention of acute rejection may outweigh the theoretical risk of infectious complications. BK viruria and viremia were common and call attention to MMF dosing and net immunosuppression.

CITATION INFORMATION: Gibney E., Ommert T., Cross R., Ray A., Lizcano J. Thymoglobulin Induction in HIV Positive Kidney Transplant Recipients: Report on Transplant and HIV Outcomes Am J Transplant. 2017;17 (suppl 3).

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