title: Survival Benefit of Kidney Transplantation in HIV-infected Patients.
abstract: To determine the survival benefit of kidney transplantation in human immunodeficiency virus (HIV)-infected patients with end-stage renal disease (ESRD).
  
  
  
  Although kidney transplantation (KT) has emerged as a viable option for select HIV-infected patients, concerns have been raised that risks of KT in HIV-infected patients are higher than those in their HIV-negative counterparts. Despite these increased risks, KT may provide survival benefit for the HIV-infected patient with ESRD, yet this important clinical question remains unanswered.
  
  
  
  Data from the Scientific Registry of Transplant Recipients were linked to IMS pharmacy fills (January 1, 2001 to October 1, 2012) to identify and study 1431 HIV-infected KT candidates from the first point of active status on the waiting list. Time-dependent Cox regression was used to establish a counterfactual framework for estimating survival benefit of KT.
  
  
  
  Adjusted relative risk (aRR) of mortality at 5 years was 79% lower after KT compared with dialysis (aRR 0.21; 95% CI 0.10-0.42; P <0.001), and statistically significant survival benefit was achieved by 194 days of KT. Among patients coinfected with hepatitis C, aRR of mortality at 5 years was 91% lower after KT compared with dialysis (aRR 0.09; 95% CI 0.02-0.46; P < 0.004); however, statistically significant survival benefit was not achieved until 392 days after KT.
  
  
  
  Evidence suggests that for HIV-infected ESRD patients, KT is associated with a significant survival benefit compared with remaining on dialysis.
authors: *Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama †Scientific Registry of Transplant Recipients, Minneapolis, Minnesota ‡Johns Hopkins University Comprehensive Transplant Center, Baltimore, Maryland §University of Pennsylvania Comprehensive Transplant Center, Philadelphia, Pennsylvania.
authors: Jayme E
authors: JE
authors: Locke
authors: Sally
authors: S
authors: Gustafson
authors: Shikha
authors: S
authors: Mehta
authors: Rhiannon D
authors: RD
authors: Reed
authors: Brittany
authors: B
authors: Shelton
authors: Paul A
authors: PA
authors: MacLennan
authors: Christine
authors: C
authors: Durand
authors: Jon
authors: J
authors: Snyder
authors: Nicholas
authors: N
authors: Salkowski
authors: Allan
authors: A
authors: Massie
authors: Deirdre
authors: D
authors: Sawinski
authors: Dorry L
authors: DL
authors: Segev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult