*Purpose: Transplantation of HIV+ individuals has become more common over the past decade with increasing data supporting good outcomes. Questions remain regarding the impact of induction and antiretroviral (ARV) choice on long-term outcomes.

*Methods: We performed a multicenter retrospective analysis of outcomes in HIV+ kidney transplant (KT) recipients from 2004-2019. Recipients of HIV + donors and kidneys with primary non-function were excluded. Outcomes included rejection, graft and patient survival stratified by induction immunosuppression and ARV regimen.

*Results: There were 78 KT in 77 patients at 5 US transplant centers. Clinical characteristics and outcomes are shown in Table 1. Rejection at any time occurred in 38% (30/78 KT). Those with rejection were more likely to be younger, African American, and to have received a deceased donor kidney (all p<0.05). Among 78 the transplants, 29 were on a protease inhibitor (PI) at KT; 11 of 29 (37%) switched to non-PI-based ARVs. This occurred more frequently after 2009 (58.8%) compared to before 2009 (8.3%). The lowest rates of rejection and highest graft survival were seen in recipients who received Anti-thymocyte globulin (rabbit) (rATG) induction and were on non-PI-based ARVs as illustrated in Figure 1a and Figure 1b. Among those receiving rATG, there was a trend to higher rejection and graft loss in those on PI-based ARV (p=0.07). There were no differences in death-censored graft loss or patient survival.

*Conclusions: Our results align with previous studies showing a benefit of rATG and non-PI-based ARVs on KT outcomes. Results from this study may influence selection of ARV regimens and induction therapy in HIV+ kidney transplant recipients.

« Back to 2021 American Transplant Congress