Choice of Induction in HIV-Infected Kidney Transplant Recipients and Its Impact On Transplant Outcomes.

Abstract

Purpose: The introduction of highly active antiretroviral therapy (HAART) has made kidney transplantation among HIV-infected patients possible. Despite the improvement in overall transplant outcomes, the incidence of acute cellular rejection (AR) in this population is high. The reasons for this have not been fully studied. We sought to examine the association of induction agent with AR and graft outcomes in these patients. Methods: From 2003 to 2013, our institution performed 45 renal transplants in HIV-infected individuals. 34 (75.6%) patients received basiliximab (BSX) and 11 (24.4%) received lymphocyte depleting (LD) agents. Mean follow up time were (43 ± 24) months in BSX and (15 ± 7) months in LD group. Results: Patient and transplant-related characteristics are summarized in Table 1.Table: No Caption available.Graft function, evidenced by SCr, was similar between groups at 3 months (1.79 ± 0.74 vs 2.09 ± 1.4, p = 0.36), 6 months (1.89 ± 1.41 vs 2.28 ± 1.94, p = 0.49), and 1 year (1.97 ± 1.38 vs 2.15 ± 1.59, p = 0.11). AR rates were similarly high in both groups.Figure: No Caption available.There were 10 (29.4%) graft losses in the BSX and 3 (27.2%) in the LD group. 5 patients in the BSX group (14.7%) and none in the LD group died during the follow up period (P=0.3). Conclusions: Our study showed a relatively high incidence of acute cellular rejection in HIV-positive renal transplant recipients. The choice of induction agent did not impact acute rejection rate, allograft function, and patient or graft survival.