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Association of tenofovir disoproxil fumarate with primary allograft survival in HIV ‐positive kidney transplant recipients
Author(s) -
Boyle Suzanne M.,
Malat Gregory,
Harhay Meera N.,
Lee Dong H.,
Pang Lisa,
Talluri Sindhura,
Sharma Akshay,
Bias Tiffany E.,
Ranganna Karthik,
Doyle Alden M.
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12727
Subject(s) - medicine , hazard ratio , kidney transplantation , transplantation , proportional hazards model , propensity score matching , kidney disease , cohort , renal function , confidence interval , surgery , urology , gastroenterology
Abstract Background Tenofovir disoproxil fumarate ( TDF ) is an antiretroviral agent frequently used to treat human immunodeficiency virus ( HIV ). There are concerns regarding its potential to cause acute kidney injury, chronic kidney disease, and proximal tubulopathy. Although TDF can effectively suppress HIV after kidney transplantation, it is unknown whether use of TDF ‐based antiretroviral therapy ( ART ) after kidney transplantation adversely affects allograft survival. Methods We examined 104 HIV + kidney transplant ( KT ) recipients at our center between 2001 and 2014. We generated a propensity score for TDF treatment using recipient and donor characteristics. We then fit Cox proportional hazards models to investigate the association between TDF treatment and 3‐year, death‐censored primary allograft failure, adjusting for the propensity score and delayed graft function ( DGF ). Results Of the 104 HIV + KT candidates who underwent transplantation during the study period, 23 (22%) were maintained on TDF ‐based ART at the time of transplantation, and 81 (78%) were on non‐ TDF ‐based ART . Median age of the cohort was 48 years; 87% were male; 88% were black; and median CD 4 count at transplantation was 450 cells/mm 3 . Median kidney donor risk index was 1.2. At 3 years post transplantation, primary allograft failure occurred in 26% of patients on TDF ‐based ART and in 28% of patients on non‐ TDF ‐based ART ( P =.5). TDF treatment was not associated with primary allograft failure at 3 years post transplant after adjusting for DGF and a propensity score for TDF use (hazard ratio 2.12, 95% confidence interval 0.41‐10.9). Conclusions In a large single‐center experience of HIV + kidney transplantation, TDF use following kidney transplantation was not significantly associated with primary allograft failure. These results may help inform management for HIV + KT recipients in need of TDF therapy for adequate viral suppression.