Impact of Induction Therapy on Outcomes in HIV + Renal Transplant Recipients

C. Kershaw,¹ C. Rogers,^2,4 M. Pavlakis,^1,2 H. Tang,² C. Alonso,^1,2 K. Khwaja,^2,3 A. Evenson,^2,3 K. Raven,^2,3 M. Wong.^1,2

¹Medicine, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA
²The Transplant Institute, BIDMC, Boston, MA
³Surgery, BIDMC, Boston, MA
⁴Pharmacy, BIDMC, Boston, MA.

Meeting: 2015 American Transplant Congress

Abstract number: 284

Keywords: HIV virus, Induction therapy, Kidney transplantation

Session Information

Session Name: Concurrent Session: Kidney: Induction

Session Type: Concurrent Session

Date: Monday, May 4, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 4:12pm-4:24pm

Location: Room 120-ABC

Purpose: Kidney transplantation in HIV+ recipients has been complicated by higher than expected acute rejection rates (AR). Induction immunosuppression may or may not impact this outcome. The purpose of our study is to assess the role of induction therapy on AR, patient and allograft survival, infection and CD4 + t cell recovery.

Methods: Retrospective review of HIV+ renal transplant recipients who received induction therapy (n=30) between 2004-2014, including patients reported in the HIV-TR multisite study (U01 AI052748). Patients received induction with rabbit antithymocyte globulin (rATG) or basiliximab, tacrolimus, mycophenolate mofetil and corticosteroids.

Table 1
	Basiliximab induction (n=14)	rATG induction (n=16)	P value
Recipient age	47.1 ± 7.3	46.6 ± 8.5	0.86
African American	10 (71)	3 (19)	0.01
Caucasian	4 (29)	6 (38)	0.71
Hispanic	0	4 (25)	0.10
Other race	0	3 (19)	0.23
Male gender	11 (79)	14 (88)	0.64
HCV+	1 (7)	4 (25)	0.34
Living donor	5 (36)	3 (19)	0.42
Deceased donor	9 (64)	13 (81)	0.42
Delayed graft function	6 (43)	9 (56)	0.72
Median length of follow-up (years)	7.6 ± 2.4	4.2 ± 1.9	<0.001
Rejection at 1 year	3 (21)	2 (14)	0.64
Rejection at 3 years (cumulative)	5 (36)	2 (14)	0.20
1 year patient survival	14 (100)	16 (100)	1.00
1 year graft survival	11 (79)	14 (88)	0.64
Serious infections (per patient)	3.7 ± 2.9	1.1 ± 1.4	0.06

All data presented as mean ± standard deviation or number (%)

A trend towards lower AR at 3 years, and higher 1-year graft survival was observed in the rATG group. CD4 counts were only significantly lower in the rATG group at 8 weeks (170±88 vs. 340±157, p=0.004) and 1 year post transplant (250±79vs. 414±231, p=0.03). There were no opportunistic infections.

Our data suggests a trend towards reduced AR, graft failure and serious infections with use of rATG. CD4 + t cell suppression was less than expected and not associated with an increase in infections. The data from this retrospective cohort suggests that rATG induction may be advantageous in the HIV+ renal transplant population.

To cite this abstract in AMA style:

Kershaw C, Rogers C, Pavlakis M, Tang H, Alonso C, Khwaja K, Evenson A, Raven K, Wong M. Impact of Induction Therapy on Outcomes in HIV + Renal Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-induction-therapy-on-outcomes-in-hiv-renal-transplant-recipients/. Accessed November 21, 2024.

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