Increased Mortality and Graft Loss With Kidney Retransplantation Among Human Immunodeficiency Virus (HIV)-Infected Recipients.
Excellent outcomes have been demonstrated in primary human immunodeficiency virus (HIV)-positive (HIV+) kidney transplant recipients, but a subset will lose their graft and seek retransplantation (re-KT). To date, no study has examined outcomes among HIV+ re-KT recipients. We studied risk for death and graft loss among 4149 (22 HIV+ vs. 4127 HIV-negative [HIV-]) adult re-KT recipients reported to the Scientific Registry of Transplant Recipients (SRTR) (2004-2013). Compared to HIV- re-KT recipients, HIV+ re-KT recipients were more commonly African American (63.6% vs. 26.7%, p < 0.001), infected with hepatitis C (31.8% vs. 5.0%, p < 0.001) and had longer median time on dialysis (4.8 years vs. 2.1 years, p = 0.02). There were no significant differences in length of time between the primary and re-KT events by HIV status (1.5 years vs. 1.4 years, p = 0.52). HIV+ re-KT recipients experienced a 3.11-fold increased risk of death (adjusted hazard ratio [aHR]: 3.11, 95% confidence interval [CI]: 1.82-5.34, p < 0.001) and a 1.96-fold increased risk of graft loss (aHR: 1.96, 95% CI: 1.14-3.36, p = 0.01) compared to HIV- re-KT recipients. Re-KT among HIV+ recipients was associated with increased risk for mortality and graft loss. Future research is needed to determine if a survival benefit is achieved with re-KT in this vulnerable population.
University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL.
B A
BA
Shelton
University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL.
S
S
Mehta
University of Pennsylvania Comprehensive Transplant Center, Philadelphia, PA.
D
D
Sawinski
University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL.
R D
RD
Reed
University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL.
P A
PA
MacLennan
Scientific Registry of Transplant Recipients, Minneapolis, MN.
S
S
Gustafson
Johns Hopkins University Comprehensive Transplant Center, Baltimore, MD.
D L
DL
Segev
University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL.
J E
JE
Locke
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D015658:HIV Infections / Q000401:mortality* / Q000601:surgery / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery / Q000821:virology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D066027:Transplant Recipients
clinical research/practice; graft survival; infection and infectious agents; kidney transplantation/nephrology; patient survival; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)