Improved Outcomes Over the Past 13 Years in HIV Positive Kidney Transplant Recipients-A Single Center Experience

A. Mattiazzi¹, J. F. Camargo², S. Anjan², M. I. Morris², L. Abbo², J. Simkins², Y. Natori², K. Aoke³, A. Zilli³, R. Thurston³, M. Muldoon³, L. Preczewski³, L. J. Chen⁴, G. W. Burke⁴, G. Ciancio⁴, G. Guerra¹

¹Medicine. Division of Nephrology, University of Miami/Miami Transplant Institute, Miami, FL, ²Medine. Division of Infectious Disease, University of Miami/Miami Transplant Institute, Miami, FL, ³Miami Transplant Institute, Miami, FL, ⁴Surgery, University of Miami/Miami Transplant Institute, Miami, FL

Meeting: 2020 American Transplant Congress

Abstract number: 276

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

Session Information

Session Name: Kidney Infections Excluding Polyoma & Viral Hepatitis

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 4:15pm-4:27pm

Location: Virtual

*Purpose: Kidney transplantation in HIV positive recipients (HIV+) is the treatment of choice for renal failure in patients (P) who maintain CD4+ counts ≥ 200/mm³and undetectable HIV load on antiretroviral therapy. Long term outcomes data are limited. The aim of our study is to report long term clinical outcomes in HIV+ kidney transplant recipients.

*Methods: We conducted a single-center, retrospective review of all HIV+P transplanted from 10/2006 to 10/2019. Main outcomes assessed at 1, 3, and 5 years: patient survival, death-censored graft survival, renal function (eGFR), biopsy-proven acute rejection (BPAR), and infections requiring hospitalization during the first year. All patients received induction: Anti-thymocyte globulin (ATG) (3mg/kg), IL2R blockers, and methylprednisolone, and 7 also received rituximab (375 mg/m²); maintenance immunosuppression: tacrolimus, mycophenolate mofetil plus steroids except one patient received Belatacept.

*Results: A total of 80 HIV+P were transplanted during the study period, only one was a re-transplant. 53 (66%) males, 27 (34%) females with a median age of 50 years old (32-75); 62 (78%) African-American, 12 (15%) Caucasian, 3 (4%) Hispanic and 3 (4%) other race; 19% received living donor and 81% received deceased donor organs. cPRA was < 40 % in 71 (89%), between 40-79% in 7 (8%) and >80% in 2 (3%) HIV+P; median CD4+ count at transplant was 492/mm³ (205-1448). Median follow up was 997 days (4-2794). 16% had delayed graft function. 15 HIV+P had BPAR at 1 year (19%): 67% T cell, 29% mixed and 4% antibody mediated rejection (AMR); and 9 HIV+P (11%) thereafter (up to 8 years) with 37.5% T cell and mixed rejection and 25% AMR. Out of 65 patients, 18 (27%) required admission during the first-year secondary to infection. HIV+P survival was 93%, 85% and 84%, and death censored graft survival was 92%, 86% and 72% at 1, 3, and 5 years, respectively. Median serum creatinine was 1.5 (0.7-6.2), 1.5 (0.8-4.1), and 2.8 (0.6-15) mg/dl; and eGFR by CKD-EPI was 65 (10-120), 63 (15-110), and 53 (4-130) ml/min at 1 (N=57), 3 (N=41) and 5 (N=27) years, respectively without statistical significance when adjusted by donor type and rejection episodes.

*Conclusions: Our single center long term clinical outcomes in HIV+ P showed lower incidence of rejection than reported in the literature and equivalent patient and graft survival at 1, 3 and 5 years.

To cite this abstract in AMA style:

Mattiazzi A, Camargo JF, Anjan S, Morris MI, Abbo L, Simkins J, Natori Y, Aoke K, Zilli A, Thurston R, Muldoon M, Preczewski L, Chen LJ, Burke GW, Ciancio G, Guerra G. Improved Outcomes Over the Past 13 Years in HIV Positive Kidney Transplant Recipients-A Single Center Experience [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/improved-outcomes-over-the-past-13-years-in-hiv-positive-kidney-transplant-recipients-a-single-center-experience/. Accessed November 22, 2024.

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