Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients

J. E. Locke, R. D. Reed, S. G. Mehta, C. Durand, R. B. Mannon, P. Maclennan, B. Shelton, M. Y. Martin, H. Qu, R. Shewchuk, D. L. Segev

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21 Scopus citations

Abstract

Excellent outcomes among HIV+ kidney transplant (KT) recipients have been reported by the NIH consortium, but it is unclear if experience with HIV+ KT is required to achieve these outcomes. We studied associations between experience measures and outcomes in 499 HIV+ recipients (SRTR data 2004-2011). Experience measures examined included: (1) center-level participation in the NIH consortium; (2) KT experiential learning curve; and (3) transplant era (2004-2007 vs. 2008-2011). There was no difference in outcomes among centers early in their experience (first 5 HIV+ KT) compared to centers having performed >6 HIV+ KT (GS adjusted hazard ratio [aHR]: 1.05, 95% CI: 0.68-1.61, p = 0.82; PS aHR: 0.93; 95% CI: 0.56-1.53, p = 0.76), and participation in the NIH-study was not associated with any better outcomes (GS aHR: 1.08, 95% CI: 0.71-1.65, p = 0.71; PS aHR: 1.13; 95% CI: 0.68-1.89, p = 0.63). Transplant era was strongly associated with outcomes; HIV+ KTs performed in 2008-2011 had 38% lower risk of graft loss (aHR: 0.62; 95% CI: 0.42-0.92, p = 0.02) and 41% lower risk of death (aHR: 0.59; 95% CI: 0.39-0.90, p = 0.01) than that in 2004-2007. Outcomes after HIV+ KT have improved over time, but center-level experience or consortium participation is not necessary to achieve excellent outcomes, supporting continued expansion of HIV+ KT in the US.

Original languageEnglish (US)
Pages (from-to)2096-2104
Number of pages9
JournalAmerican Journal of Transplantation
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2015

Keywords

  • (SRTR)
  • Scientific Registry for Transplant Recipients
  • clinical research/practice
  • graft survival
  • health services and outcomes research
  • infection and infectious agents
  • infectious disease
  • kidney (allograft) function/dysfunction
  • kidney transplantation/nephrology
  • patient survival
  • viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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    Locke, J. E., Reed, R. D., Mehta, S. G., Durand, C., Mannon, R. B., Maclennan, P., Shelton, B., Martin, M. Y., Qu, H., Shewchuk, R., & Segev, D. L. (2015). Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients. American Journal of Transplantation, 15(8), 2096-2104. https://doi.org/10.1111/ajt.13220