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Identification of Optimal Donor–Recipient Combinations Among Human Immunodeficiency Virus (HIV)–Positive Kidney Transplant Recipients
Author(s) -
Locke J. E.,
Shelton B. A.,
Reed R. D.,
MacLennan P. A.,
Mehta S.,
Sawinski D.,
Segev D. L.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13847
Subject(s) - medicine , hazard ratio , confidence interval , kidney transplantation , human immunodeficiency virus (hiv) , human leukocyte antigen , risk factor , transplantation , hepatitis c virus , immunology , gastroenterology , virus , antigen
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 HLA with more than three MM s) recipients had a 3.86‐fold increased risk compared to low‐ HIV ‐risk ( HIV‐positive / HCV‐negative HLA with three or fewer MM s)) recipients ( aHR : 3.86, 95% CI : 2.37–6.30, p < 0.001). Avoidance of more than three HLA MM s in HIV‐positive KT recipients, particularly among coinfected patients, may mitigate the increased risk of graft loss associated with HIV infection.