title: Identification of Optimal Donor-Recipient Combinations Among Human Immunodeficiency Virus (HIV)-Positive Kidney Transplant Recipients.
abstract: For some patient subgroups, human immunodeficiency virus (HIV) infection has been associated with worse outcomes after kidney transplantation (KT); potentially modifiable factors may be responsible. The study goal was to identify factors that predict a higher risk of graft loss among HIV-positive KT recipients compared with a similar transplant among HIV-negative recipients. In this study, 82 762 deceased donor KT recipients (HIV positive: 526; HIV negative: 82 236) reported to the Scientific Registry of Transplant Recipients (SRTR) (2001-2013) were studied by interaction term analysis. Compared to HIV-negative recipients, the hepatitis C virus (HCV) amplified risk 2.72-fold among HIV-positive KT recipients (adjusted hazard ratio [aHR]: 2.72, 95% confidence interval [CI]: 1.75-4.22, p < 0.001). Forty-three percent of the excess risk was attributable to the interaction between HIV and HCV (attributable proportion of risk due to the interaction [AP]: 0.43, 95% CI: 0.23-0.63, p = 0.02). Among HIV-positive recipients with more than three HLA mismatches (MMs), risk was amplified 1.80-fold compared to HIV-negative (aHR: 1.80, 95% CI: 1.31-2.47, p < 0.001); 42% of the excess risk was attributable to the interaction between HIV and more than three HLA MMs (AP: 0.42, 95% CI: 0.24-0.60, p = 0.01). High-HIV-risk (HIV-positive/HCV-positive HLAwith more than three MMs) recipients had a 3.86-fold increased risk compared to low-HIV-risk (HIV-positive/HCV-negative HLA with three or fewer MMs)) recipients (aHR: 3.86, 95% CI: 2.37-6.30, p < 0.001). Avoidance of more than three HLA MMs in HIV-positive KT recipients, particularly among coinfected patients, may mitigate the increased risk of graft loss associated with HIV infection.
authors.affiliation: University of Alabama at Birmingham, Comprehensive Transplant Institute, Birmingham, AL.
authors.forename: J E
authors.initials: JE
authors.lastname: Locke
authors.affiliation: University of Alabama at Birmingham, Comprehensive Transplant Institute, Birmingham, AL.
authors.forename: B A
authors.initials: BA
authors.lastname: Shelton
authors.affiliation: University of Alabama at Birmingham, Comprehensive Transplant Institute, Birmingham, AL.
authors.forename: R D
authors.initials: RD
authors.lastname: Reed
authors.affiliation: University of Alabama at Birmingham, Comprehensive Transplant Institute, Birmingham, AL.
authors.forename: P A
authors.initials: PA
authors.lastname: MacLennan
authors.affiliation: University of Alabama at Birmingham, Comprehensive Transplant Institute, Birmingham, AL.
authors.forename: S
authors.initials: S
authors.lastname: Mehta
authors.affiliation: University of Pennsylvania Comprehensive Transplant Center, Philadelphia, PA.
authors.forename: D
authors.initials: D
authors.lastname: Sawinski
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications / Q000601:surgery*; D015497:HIV-1 / Q000302:isolation & purification; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications / Q000601:surgery*; D006650:Histocompatibility Testing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
keywords: clinical research/practice; health services and outcomes research; immune deficiency; infection and infectious agents; infectious disease; kidney transplantation/nephrology; viral: hepatitis C; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)