*Purpose: Since the introduction of highly active antiretroviral therapy, HIV+ individuals are living longer, which has led to higher rates of end stage renal disease and kidney transplantation has become of increasing interest in this demographic. Renal allograft survival in HIV+ patients has lagged behind that of comparable cohorts and has been associated with increased rates of acute rejection. Additionally, increased rates of positive cross-matches in these recipients has impacted organ utilization. This study focuses on outcomes of kidney transplantation in HIV+ patients who are highly sensitized as described by a PRA value 90%-100% and/or with a positive cross match.

*Methods: Data was gathered from the 2018 UNOS database, in which a total of 1530 HIV+ patients who received kidney transplants were selected. PRA values were grouped to create sensitization levels: non-sensitized (0%), low (1%-50%), medium (51%-89%), and highly sensitized (90%-100%). A demographics table was created to compare characteristics and outcomes between the four sensitization groups. A separate demographics table was created for non-sensitized and highly sensitized groups who also had a positive cross match. Subject characteristics were summarized using means and standard deviations or frequencies and percentages, as applicable. Significance between groups was determined by independent samples t-tests and χ² tests (α = 0.05.). Death-censored graft survival for various subgroups was estimated using Kaplan-Meier with Log-Rank to assess significance. All analysis was completed using SPSS Statistics 26.

*Results: The median graft survival for all 1530 patients is 792 days. The median graft survival for the non-sensitized group is 738 days while the median graft survival for the highly sensitized group is 990 days. The corresponding Kaplan-Meier graph displays no significant difference in the survival curves of the four groups; furthermore the highly sensitized group is the highest curve. The median graft survival for the non-sensitized group with a positive cross match is 2031 days while the median graft survival for the highly sensitized group with a positive cross match is 1606.5 days. The corresponding Kaplan-Meier graph displays that the survival curve of the highly sensitized group is slightly less than that of the non-sensitized group.

*Conclusions: Graft survival is comparable for the highly sensitized compared to the non-sensitized group.HIV+ patients with a PRA value >= 90% should not be excluded from transplantation nor considered at higher risk when compared to non-sensitized patients. The highly sensitized HIV+ patients with a positive cross match did exhibit a lower median graft survival, however, when comparing both the non-sensitized and highly sensitized to the overall study population, both groups had significantly higher median graft survival.

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