Background: Kidney transplant graft survival remains suboptimal in HIV (+) patients. We, and others, have reported an association of both DGF with markedly inferior graft outcomes. More recently, KDRI has been validated as a tool to predict graft outcomes but has not been well characterized for HIV (+) transplant patients. We sought to investigate the overlapping effects between DGF and KDRI on graft survival within a large single center experience of HIV KTx.

Methods: We retrospectively examined 91 sequential deceased donor HIV KTx. Unadjusted KDRI was calculated for each recipient. We compared two groups: the highest KDRI (high KDRI) vs. the lowest score (low KDRI). We then examined the total cohort for the incidence DGF, and compared those with the highest KDRI + DGF vs. the lowest KDRI + DGF. KDRI values were mapped to the 2012 KDPI table. KDRI values correlating to the newly established 85% KDPI limit were identified as the cutoff for the two groups.

Results: Demographics of the two groups similar (Table 1). The KDRI was used to compare graft survival between the 2 groups and as expected, was worse in the high KDRI group (p=0.01, data not shown). When KDRI was used to compare graft survival in HIV (+) transplant recipients among the group that had DGF, we found no difference in graft outcomes between high- and low-KDRI groups. Graft function (eGFR) was markedly worse in the high KDRI group.

Conclusion: High KDRI performed less well than presence/absence of DGF as a predictor of poor graft survival for HIV (+) kidney transplant patients. This may suggest that factors associated with DGF, beyond those captured in KDRI, may play a prominent role in graft survival in this population.

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