title: Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients.
abstract: Excellent outcomes among HIV+ kidney transplant (KT) recipients have been reported by the NIH consortium, but it is unclear if experience with HIV+ KT is required to achieve these outcomes. We studied associations between experience measures and outcomes in 499 HIV+ recipients (SRTR data 2004-2011). Experience measures examined included: (1) center-level participation in the NIH consortium; (2) KT experiential learning curve; and (3) transplant era (2004-2007 vs. 2008-2011). There was no difference in outcomes among centers early in their experience (first 5 HIV+ KT) compared to centers having performed >6 HIV+ KT (GS adjusted hazard ratio [aHR]: 1.05, 95% CI: 0.68-1.61, p = 0.82; PS aHR: 0.93; 95% CI: 0.56-1.53, p = 0.76), and participation in the NIH-study was not associated with any better outcomes (GS aHR: 1.08, 95% CI: 0.71-1.65, p = 0.71; PS aHR: 1.13; 95% CI: 0.68-1.89, p = 0.63). Transplant era was strongly associated with outcomes; HIV+ KTs performed in 2008-2011 had 38% lower risk of graft loss (aHR: 0.62; 95% CI: 0.42-0.92, p = 0.02) and 41% lower risk of death (aHR: 0.59; 95% CI: 0.39-0.90, p = 0.01) than that in 2004-2007. Outcomes after HIV+ KT have improved over time, but center-level experience or consortium participation is not necessary to achieve excellent outcomes, supporting continued expansion of HIV+ KT in the US.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: J E
authors.initials: JE
authors.lastname: Locke
authors.affiliation: Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: R D
authors.initials: RD
authors.lastname: Reed
authors.affiliation: Department of Medicine, Division of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: S G
authors.initials: SG
authors.lastname: Mehta
authors.affiliation: Department of Medicine, Division of Infectious Disease, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: C
authors.initials: C
authors.lastname: Durand
authors.affiliation: Department of Medicine, Division of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: R B
authors.initials: RB
authors.lastname: Mannon
authors.affiliation: Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: P
authors.initials: P
authors.lastname: MacLennan
authors.affiliation: Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: B
authors.initials: B
authors.lastname: Shelton
authors.affiliation: Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: M Y
authors.initials: MY
authors.lastname: Martin
authors.affiliation: Department of Health Services Administration, University of Alabama at Birmingham School of Health Professions, Birmingham, AL.
authors.forename: H
authors.initials: H
authors.lastname: Qu
authors.affiliation: Department of Health Services Administration, University of Alabama at Birmingham School of Health Professions, Birmingham, AL.
authors.forename: R
authors.initials: R
authors.lastname: Shewchuk
authors.affiliation: Department of Medicine, Division of Infectious Disease, Johns Hopkins Medical Institutions, Baltimore, MD.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015658:HIV Infections / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D014481:United States; D055815:Young Adult
keywords: (SRTR); Scientific Registry for Transplant Recipients; clinical research/practice; graft survival; health services and outcomes research; infection and infectious agents; infectious disease; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; patient survival; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)