*Purpose: HIV+ patients are eligible to recieve a kidney transplant (KT) provided they meet criteria of undetectable viral load (VL) and CD4 count >200. We compare the long term transplant outcomes between HIV+ and HIV-kidney transplant reciepients (KTRs).

*Methods: This is a retrospective analysis of HIV+ patients who received a KT from 2005 to 2018 at an urban academic center. Allograft and patient survival between HIV + and HIV – KTRs using Kaplan-Meier survival estimates at one-, three-, and five-year were compared. Secondary outcomes including incidence of biopsy proven acute rejection (BPAR) and BK virus associated nephropathy (BKVAN) and cytomegalovirus (CMV) disease were reviewed.

*Results: We identified 21 HIV+ KTRs, 86% African American, 9% Hispanic, and 5% Caucasian. The median age was 47 years (interquartile range [IQR], 36-53),a median BMI of 27 (IQR, 23-33),dialysis vintage median period of 5.5 years (IQR, 1.4-7.6) and 67% were male. Of the 13 living donor KTs, 2 were ABO incompatible and 2 were crossmatch positive. Nine KTRs received an antiretroviral combination including nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) with a non-nucleoside reverse transcriptase inhibitor, 7 received NRTIs with a protease inhibitor, and 6 received NRTIs with an integrase inhibitor. Five (24%) KTRs were co-infected with HCV. PRIMARY OUTCOMES: There was no difference in the 1- and 3 year graft and patient survival between HIV+ and HIV- KTRs, but the 5-year patient survival was significantly lower in the HIV+ KTRs (P < 0.05). Table. SECONDARY OUTCOMES: The incidence of BPAR was 25% at 1 year and 20% at 3 years. There were no new cases of BPAR at the 5-year follow-up. All BPARs, were T-cell mediated except one case of mixed cellular and antibody-mediated rejection. Of the five HIV+ recipients co-infected with HCV, the incidence of BPAR was 60% within 1-year of KT. The incidence of BKVAN was 19.7 per 100 person-years and 7.9 per 100 person-years for CMV disease during the five-year follow-up.

*Conclusions: The mandate of undetectable VL may explain the comparable graft and patient survival rates among HIV+ and HIV- KTRs in the early years post-KT. The lower patient survival at 5 years in HIV+ KTRs compared to HIV-KTRs should be further analyzed. This may be associated with the increased morbidity associated with HIV+ status. Rates of infection were not different between the 2 groups. HIV replication was well controlled in all but one patient due to medication non-adherence. No recurrence of HIVAN was reported. Studies of a larger cohort with a longer follow up periods are needed.

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