Kidney Transplantation Rejection Remains High With HIV

While antiretroviral therapy has allowed HIV patients to undergo kidney transplantation, allograft rejection remains high in this group.
While antiretroviral therapy has allowed HIV patients to undergo kidney transplantation, allograft rejection remains high in this group.

NEW ORLEANS – Kidney transplantation in patients with HIV is associated with higher allograft rejection compared with patients without HIV, according to a presentation at IDWeek 2016. Clinical and fiscal outcomes, however, were the same between both groups.

Senu Apewokin, MD, medical director of transplant infectious diseases at the University of Cincinnati, Ohio, and colleagues identified candidates for kidney transplantation and patients with HIV between 2008 and 2013 using the Inpatient Databases of the Healthcare Cost and Utilization Project. Kidney transplantation patients were identified by procedural codes while ICD-9 codes were used to identify patients with HIV.

Of the 104,137 patient data reviewed, 605 patients were HIV positive. Most of these patients were younger (between 35 to 49 years of age), were of African American descent, and had Medicare as a primary payer.  Income was not a factor between the two groups.

The researchers compared length of stay, total hospital charges, hours spent receiving mechanical ventilation (<96 and ≥96 hours), and infectious complications and found no significant differences between patients with HIV and without HIV. A statistically significant difference was noted, however, when comparing allograft rejection rates (27.5 in patients with HIV vs 20.75 in patients without HIV; P <.001).

Potential limitations to this study include its retrospective design, use of imputed data and ICD-9 codes for extractions, and an inability to assess long-term outcomes since inpatient samples were used.

While antiretroviral therapy (ART) has allowed patients with HIV and advanced kidney disease to undergo kidney transplantation, allograft rejection remains high in this group. More research is therefore warranted to understand the underlying causes for organ rejection.

Learn more about Dr Apewokin's presentation by watching the video below. 

Reference

1. Apewokin S, Madan R, Restrepo A, Hemmige VS, Arora S. Clinical and healthcare utilization outcomes of kidney transplantation in HIV-positive recipients: a nationwide analysis from 2008-2013. Presented at: IDWeek 2016. New Orleans, LA; October 26-30, 2016. Abstract 79.

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