Background: Excellent outcomes among HIV+ kidney transplant (KT) recipients have been reported by the NIH consortium, but it is unclear if experience with HIV+ KT is required to achieve these outcomes.

Methods: We studied associations between experience measures and outcomes in 499 HIV+ recipients (SRTR data 2004-2011). Experience measures included: (1) center participation in the NIH consortium; (2) KT experiential learning curve; and (3) transplant era (2004-2007 vs. 2008-2011). Graft (GS) and patient survival (PS) were examined using Cox proportional hazards modeling, with a sandwich estimator for within-center clustering. Models adjusted for donor age and type; recipient age, race, hepatitis C, history of prior KT; immunosuppression regimen; transplant year.

Results: There was no difference in outcomes among centers early in their experience (first 5 HIV+ KT) compared to centers having performed ≥ 6 HIV+ KT [GS adjusted hazard ratio (aHR): 1.00, CI: 0.67-1.49, p=0.99; PS aHR: 0.91; CI: 0.55-1.48, p=0.69]. Participation in the NIH-study was not associated with better outcomes [GS aHR: 1.10, CI: 0.72-1.69, p=0.65; PS aHR: 1.14; CI: 0.67-1.95, p=0.63]. Transplant era was strongly associated with outcomes; HIV+ KTs performed in 2008-2011 had 37% lower risk of graft loss [aHR: 0.63, CI: 0.42-0.95, p=0.03] and 36% lower risk of death [aHR: 0.64, CI: 0.42-0.98, p=0.04] than in 2004-2007.

Conclusions: Outcomes after HIV+ KT have improved over time, but center-level experience or consortium participation is not necessary to achieve excellent outcomes, supporting continued expansion of HIV+ KT.

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