Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2017 Mar;265(3):604-608.
doi: 10.1097/SLA.0000000000001761.

Survival Benefit of Kidney Transplantation in HIV-infected Patients

Jayme E Locke  1 , Sally Gustafson, Shikha Mehta, Rhiannon D Reed, Brittany Shelton, Paul A MacLennan, Christine Durand, Jon Snyder, Nicholas Salkowski, Allan Massie, Deirdre Sawinski, Dorry L Segev
Affiliations
Comparative Study

Survival Benefit of Kidney Transplantation in HIV-infected Patients

Jayme E Locke et al. Ann Surg. 2017 Mar.

Abstract

Objective: To determine the survival benefit of kidney transplantation in human immunodeficiency virus (HIV)-infected patients with end-stage renal disease (ESRD).

Summary background data: Although kidney transplantation (KT) has emerged as a viable option for select HIV-infected patients, concerns have been raised that risks of KT in HIV-infected patients are higher than those in their HIV-negative counterparts. Despite these increased risks, KT may provide survival benefit for the HIV-infected patient with ESRD, yet this important clinical question remains unanswered.

Methods: Data from the Scientific Registry of Transplant Recipients were linked to IMS pharmacy fills (January 1, 2001 to October 1, 2012) to identify and study 1431 HIV-infected KT candidates from the first point of active status on the waiting list. Time-dependent Cox regression was used to establish a counterfactual framework for estimating survival benefit of KT.

Results: Adjusted relative risk (aRR) of mortality at 5 years was 79% lower after KT compared with dialysis (aRR 0.21; 95% CI 0.10-0.42; P <0.001), and statistically significant survival benefit was achieved by 194 days of KT. Among patients coinfected with hepatitis C, aRR of mortality at 5 years was 91% lower after KT compared with dialysis (aRR 0.09; 95% CI 0.02-0.46; P < 0.004); however, statistically significant survival benefit was not achieved until 392 days after KT.

Conclusions: Evidence suggests that for HIV-infected ESRD patients, KT is associated with a significant survival benefit compared with remaining on dialysis.

PubMed Disclaimer

Conflict of interest statement

OF CONFLICTS The other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Adjusted relative mortality risk among HIV+ kidney transplant recipients compared to remaining on dialysis.
Figure 2
Figure 2
Adjusted relative mortality risk among HIV-infected living donor and deceased donor kidney transplant recipients compared to remaining on dialysis.
Figure 3
Figure 3
Adjusted relative mortality risk among HIV/HCV coinfected kidney transplant recipients compared to remaining on dialysis.
See this image and copyright information in PMC

References

    1. Eggers PW, Kimmel PL. Is there an epidemic of HIV Infection in the US ESRD program? J Am Soc Nephrol. 2004;15:2477–2485. - PubMed
    1. United States Renal Data System (USRDS) 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. 2011 - PubMed
    1. Mallipattu SK, Wyatt CM, He JC. The New Epidemiology of HIV-Related Kidney Disease. J AIDS Clin Res. 2012;(Suppl 4):001. - PMC - PubMed
    1. Abraham AG, Althoff KN, Jing Y, et al. End-stage renal disease among HIV-infected adults in North America. Clin Infect Dis. 2015;60:941–949. - PMC - PubMed
    1. Schwartz EJ, Szczech LA, Ross MJ, Klotman ME, Winston JA, Klotman PE. Highly active antiretroviral therapy and the epidemic of HIV+ end-stage renal disease. J Am Soc Nephrol. 2005;16:2412–2420. - PubMed

Publication types

MeSH terms