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.
|Demographics||Low Risk KDRI (n=60)||High Risk KDRI (n=31)||p-value|
|African American (%)||87||94||0.25|
|Recipient Age (mean ± s.d.)||47 ± 9.3||50 ± 8.1||0.13|
|CIT (mean ± s.d.)||16 ± 6.1||16 ± 5.4||0.96|
|Mixed Rejection (%)||18||10||0.37|
|1 yr. eGFR (mean ± s.d.)||40.0 ± 30.0||25.4 ± 24.0||0.04|
|3 yr eGFR (mean ± s.d.)||29.3 ± 33.5||9.3 ± 15.6||0.01|
|Best eGFR (mean ± s.d.)||58.8 ± 28.2||44.0 ± 19.7||0.02|
To cite this abstract in AMA style:Malat G, Ranganna K, Guy S, Xiao G, Reich D, Doyle A. Impact of Delayed Graft Function (DGF) and KDRI on Kidney Graft Survival in HIV (+) Transplant Recipients (HIV KTx) [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/impact-of-delayed-graft-function-dgf-and-kdri-on-kidney-graft-survival-in-hiv-transplant-recipients-hiv-ktx/. Accessed November 15, 2019.
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