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

Abstract

PurposeKidney 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.MethodsWe 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.ResultsSeventy‐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.ConclusionsIn 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. image