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Multicenter Study
. 2024 Aug;26(4):e14287.
doi: 10.1111/tid.14287. Epub 2024 May 2.

Influence of induction therapy and antiretroviral regimen on outcomes in kidney transplant recipients living with human immunodeficiency

Christin Rogers Marks  1 , Christine M Durand  2 , Mary G Bowring  2 , Jonathan Hand  3   4 , Maheen Z Abidi  5 , Maricar Malinis  6 , Brittany Barnaba  2 , Het Patel  7 , Martha Pavlakis  7   8 , Carolyn D Alonso  1   8
Affiliations
Multicenter Study

Influence of induction therapy and antiretroviral regimen on outcomes in kidney transplant recipients living with human immunodeficiency

Christin Rogers Marks et al. Transpl Infect Dis. 2024 Aug.

Abstract

Purpose: Kidney transplantation has a survival benefit for people with human immunodeficiency virus (HIV) and end-stage kidney disease, however increased rates of rejection remain an issue. Questions remain regarding the impact of induction immunosuppression therapy and antiretroviral (ARV) choice on long-term outcomes.

Methods: We performed a multicenter retrospective analysis of outcomes in recipients with HIV who received kidneys from donors without HIV transplanted between 2004 and 2019. The association between induction and ARV regimens and long-term outcomes including rejection, graft, and recipient survival over 5 years was investigated using Cox regression modeling.

Results: Seventy-eight kidney transplants (KT) performed in 77 recipients at five US transplant centers were included, with median follow up of 7.1 (4.3-10.7) years. Overall recipient and graft survival were 83% and 67%, respectively. Rejection occurred in 37% (29/78). Recipients with rejection were more likely to be younger, recipients of deceased donor organs, and Black. Receipt of rabbit anti-thymocyte globulin (rATG) induction without protease-inhibitor (PI)-based ARVs was associated with 83% lower risk of rejection (adjusted hazard ratio (aHR) 0.17 (95% CI 0.05-0.63), p =.007) and a non-statistically significantly lower risk of graft failure (aHR 0.18 (0.03-1.16), p =.07) when compared to those who received other induction and ARV combinations.

Conclusions: In this multicenter retrospective study, we found a trend toward lower rejection and improved graft survival among those who received both rATG for induction and PI-sparing ARVs.

Keywords: human immunodeficiency virus; rejection; transplantation.

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Figures

Figure 1 –
Figure 1 –. Five Year rejection free survival in patients receiving non-protease inhibitor based antiretroviral regimens with anti-thymocyte globulin (No PI rATG) induction vs all others
* Others includes those receiving the following combinations: protease inhibitor based antiretroviral regimens with anti-thymocyte globulin induction, non-protease inhibitor based antiretroviral regimens with basiliximab induction and protease inhibitor based antiretroviral regimens with basiliximab induction
Figure 2 –
Figure 2 –. Five year kidney graft survival in patients receiving non-protease inhibitor based antiretroviral regimens with anti-thymocyte globulin (No PI rATG) induction vs all others
* Others includes those receiving the following combinations: protease inhibitor based antiretroviral regimens with anti-thymocyte globulin induction, non-protease inhibitor based antiretroviral regimens with basiliximab induction and protease inhibitor based antiretroviral regimens with basiliximab induction
See this image and copyright information in PMC

Comment in

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