Immunosuppression Regimen and the Risk of Acute Rejection in HIV-Infected Kidney Transplant Recipients
University of Alabama at Birmingham, Birmingham
Johns Hopkins University, Baltimore
Meeting: 2013 American Transplant Congress
Abstract number: 177
Background: Kidney transplantation has been established as the therapy of choice for the treatment of end stage renal disease among appropriately selected HIV-infected (HIV+) individuals. However, acute rejection (AR) rates are more than 2-fold higher than for non-HIV-infected (HIV-) kidney transplant recipients. The optimal immunosuppression strategy for this population remains unknown.
Methods: Associations between immunosuppression regimen and development of AR at 1-year were studied among adult, HIV+, kidney-only recipients using SRTR data from 2003-2011 [n=516]. Relative risk of AR was modeled using modified multivariate Poisson regression adjusting for center participation in the NIH-study protocol, center experience, donor type and age, recipient age and race, PRA, HLA mismatch, cold ischemia time (CIT), and retransplantation. Matched control analysis among anti-thymocyte globulin induced HIV+ and HIV- kidney transplant recipients was performed.
Results: There is no difference in the risk for AR among HIV+ and HIV- anti-thymocyte globulin (ATG) induced recipients [adjusted Relative Risk (aRR) 1.16; 95%CI 0.41-3.35; p=0.77]. Further, HIV+ patients that receive ATG induction have a 2.6 fold lower risk of AR [aRR 0.39; 95%CI 0.18-0.87; p=0.02] compared to no induction therapy. Compared to calcineurin-based (CNI) maintenance therapy, HIV+ recipients maintained on sirolimus-based therapy had a 2.2 fold higher risk of AR [aRR 2.15; 95%CI 1.20-3.86; p=0.01].
Conclusion: These data support a role for ATG-induction therapy in HIV+ individuals undergoing kidney transplantation, and caution against the use sirolimus-based maintenance therapy in this population.
To cite this abstract in AMA style:
Locke J, James N, Mehta S, Pappas P, Mannon R, Desai N, Montgomery R, Segev D. Immunosuppression Regimen and the Risk of Acute Rejection in HIV-Infected Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/immunosuppression-regimen-and-the-risk-of-acute-rejection-in-hiv-infected-kidney-transplant-recipients/. Accessed December 2, 2024.« Back to 2013 American Transplant Congress