A National Study of Outcomes among HIV-Infected Kidney Transplant Recipients

Abstract

Kidney transplantation is a viable treatment for select patients with HIV and ESRD, but data are lacking regarding long-term outcomes and comparisons with appropriately matched HIV-negative patients. We analyzed data from the Scientific Registry of Transplant Recipients (SRTR; 2002-2011): 510 adult kidney transplant recipients with HIV (median follow-up, 3.8 years) matched 1:10 to HIV-negative controls. Compared with HIV-negative controls, HIV-infected recipients had significantly lower 5-year (75.3% versus 69.2%) and 10-year (54.4% versus 49.8%) post-transplant graft survival (GS) (hazard ratio [HR], 1.37; 95% confidence interval [95% CI], 1.15 to 1.64; P<0.001) that persisted when censoring for death (HR, 1.43; 95% CI, 1.12 to 1.84; P=0.005). However, compared with HIV-negative/hepatitis C virus (HCV)-negative controls, HIV monoinfected recipients had similar 5-year and 10-year GS, whereas HIV/HCV coinfected recipients had worse GS (5-year: 64.0% versus 52.0%, P=0.02; 10-year: 36.2% versus 27.0%, P=0.004 [HR, 1.38; 95% CI, 1.08 to 1.77; P=0.01]). Patient survival (PS) among HIV-infected recipients was 83.5% at 5 years and 51.6% at 10 years and was significantly lower than PS among HIV-negative controls (HR, 1.34; 95% CI, 1.08 to 1.68; P<0.01). However, PS was similar for HIV monoinfected recipients and HIV-negative/HCV-negative controls at both times. HIV/HCV coinfected recipients had worse PS compared with HIV-negative/HCV-infected controls (5-year: 67.0% versus 78.6%, P=0.007; 10-year: 29.3% versus 56.23%, P=0.002 [HR, 1.57; 95% CI, 1.11 to 2.22; P=0.01]). In conclusion, HIV-negative and HIV monoinfected kidney transplant recipients had similar GS and PS, whereas HIV/HCV coinfected recipients had worse outcomes. Although encouraging, these results suggest caution in transplanting coinfected patients.

Keywords: HIV nephropathy; hepatitis; kidney transplantation; outcomes.

Copyright © 2015 by the American Society of Nephrology.

Figures

Figure 1.

The number of kidney transplants performed among the general ESRD population and the number of kidney transplants performed among HIV+ ESRD patients between 2002 and 2011. Since 2010 there has been a steady decline in the number of HIV+ kidney transplants performed annually.

Figure 2.

GS among a matched case-controlled cohort of HIV+ and HIV− kidney transplant recipients, stratified by HCV status. (A) Monoinfected HIV+ recipients compared with HIV−/HCV− matched controls. (B) HIV+ recipients coinfected with HCV compared with HIV−/HCV+ matched controls.

Figure 3.

Death censored GS among a matched case-controlled cohort of HIV+ and HIV− kidney transplant recipients, stratified by HCV status. (A) Monoinfected HIV+ recipients compared with HIV−/HCV− matched controls. (B) HIV+ recipients coinfected with HCV compared with HIV−/HCV+ matched controls.

Figure 4.

PS among a matched case-controlled cohort of HIV+ and HIV− kidney transplant recipients, stratified by HCV status. (A) Monoinfected HIV+ recipients compared with HIV−/HCV− matched controls. (B) HIV+ recipients coinfected with HCV compared with HIV−/HCV+ matched controls.