D. Kahler1, M. Curtis2, H. Zhao3, A. Diamond4, A. DiCarlo1, S. S. Karhadkar1 1Temple University Hospital, Department Of Surgery, Philadelpha, PA, USA 2Temple University, Lewis Katz School Of Medicine, Philadelpha, PA, USA 3Temple University, Department Of Biomedical Education And Data Science, Philadelpha, PA, USA 4Temple University Hospital, Department Of Pharmacy, Philadelpha, PA, USA
Introduction: Chronic disease is common in patients living with Human Immunodeficiency Virus (HIV) infection, which has given rise to the era of kidney transplantation in patients with both End Stage Renal Disease (ESRD) and HIV infection. However, given the concern for higher rates of acute rejection in this patient population,1 some clinicians question the immunologic risk of HIV infection in kidney transplantation. A possible means of negating this risk is through living donor transplantation. The purpose of this study is to assess the benefit of living donor transplantation in this population and to ascertain the true immunologic risk faced by HIV-infected patients undergoing kidney transplant.
Methods: The 2018 UNOS database was queried, and a retrospective analysis was conducted to identify 1530 HIV-infected kidney transplant recipients since 1987. Patients were stratified based on donor status, deceased vs. living donor. Overall survival, graft survival, delayed graft function, and acute rejection were compared between groups, as were standard markers of immunologic risk – Panel Reactive Antibody (PRA) percentage and crossmatch status. Data were analyzed by t-test, chi-square test, and Cox regression analysis, as appropriate.
Results: We identified 1,226 patients who received kidneys from deceased donors (DDKT) and 304 patients who received kidneys from living donors (LDKT). Patients undergoing LDKT exhibited greater overall survival (p<0.001, Figure 1) and graft survival (p<0.001), as well as reduced incidence of delayed graft function (p<0.001) compared to DDKT. However, no difference in acute rejection was noted between the DDKT and LDKT cohorts. No difference in graft survival or acute rejection was evident in patients with high PRA percentage or crossmatch positivity, regardless of donor status.
Conclusion: Patients infected with HIV who underwent LDKT fared better than those undergoing DDKT. And yet, no difference was noted in acute rejection between these patients. Further, patients who exhibited higher immunologic risk – elevated PRA percentage and crossmatch positivity – did not experience rejection or graft loss at a higher rate than patients at lower immunologic risk. These results were valid in both the DDKT and LDKT cohorts. Thus, while LDKT is often preferable to DDKT in this population, infection with HIV does not overtly increase patients’ immunologic risk, and concerns about transplantation in this population may be overestimated.
1. Locke JE, Mehta S, Reed RD, et al. CLINICAL EPIDEMIOLOGY A National Study of Outcomes among HIV-Infected Kidney Transplant Recipients. J Am Soc Nephrol. 2015;26:2222-2229.Doi:10.1681/ASN.2014070726
