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Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients

J. Locke,1 R. Reed,1 S. Mehta,1 C. Durand,2 R. Mannon,1 P. MacLennan,1 B. Shelton,1 M. Martin,1 H. Qu,1 R. Shewchuk,1 D. Segev.2

1Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham
2Comprehensive Transplant Center, Johns Hopkins Medical Institutions, Baltimore.

Meeting: 2015 American Transplant Congress

Abstract number: 352

Keywords: Graft survival, HIV virus, Kidney transplantation, Outcome

Session Information

Date: Tuesday, May 5, 2015

Session Name: Concurrent Session: Disparities in Donation and Transplant Outcomes

Session Time: 2:15pm-3:45pm

 Presentation Time: 2:51pm-3:03pm

Location: Room 115-C

Related Abstracts
  • Outcomes of HIV+ Liver Transplant Recipients Compared to HCV+ or HIV+/HCV+ Co-Infected Recipients: The “Real World” Experience
  • Similar Outcomes Can Be Expected Among HIV (+) Kidney Transplant Recipients (HIV+ Tx) Vs. HIV (-) Kidney Transplant Recipients (HIV- Tx) Receiving Similar Immunosuppression Protocols

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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To cite this abstract in AMA style:

Locke J, Reed R, Mehta S, Durand C, Mannon R, MacLennan P, Shelton B, Martin M, Qu H, Shewchuk R, Segev D. Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/center-level-experience-and-kidney-transplant-outcomes-in-hiv-infected-recipients/. Accessed December 6, 2019.

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