Kidney Week

Abstract: FR-PO913

HIV-Infected Kidney Allograft Recipients Managed with Anti-Thymocyte Globulin Induction

Session Information

• Transplantation: Translational and Transplant Pathology
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Al Jurdi, Ayman, New York Presbyterian Hospital / Weill Cornell Medicine, New York, New York, United States

Ayman Al Jurdi,

• Liu, Esther C., New York Presbyterian, New York, New York, United States

Esther C. Liu,

• Aull, Meredith J., Weill Cornell Medical College, New York, New York, United States

Meredith J. Aull,

• Lubetzky, Michelle L., Division of Nephrology and Hypertension, New York, New York, United States

Michelle L. Lubetzky,

• Serur, David, The Rogosin Institute, New York, New York, United States

David Serur,

• Kapur, Sandip, Weill Cornell Medical College, New York, New York, United States

Sandip Kapur,

• Muthukumar, Thangamani, New York Presbyterian Hospital / Weill Cornell Medicine, New York, New York, United States

Thangamani Muthukumar,

Background

Reconsiderations of the risks involved in using immunosuppressive therapy in patients with HIV have resulted in a welcome foray into providing kidney allografts to HIV-infected patients. Anti-thymocyte globulin (ATG) induction reduces acute rejection but its use in HIV-infected kidney transplant recipients is limited. We assessed the long-term outcomes of HIV-infected kidney transplant recipients at our center managed with ATG induction.

Methods

Single center chart review of HIV-infected kidney allograft recipients between 2006 and 2016 who received induction immunosuppression with ATG. Maintenance immunosuppression included tacrolimus and mycophenolate with or without corticosteroids. Infection prophylaxis included clotrimazole, valganciclovir and co-trimoxazole. Primary outcome measures were patient and graft survival. Patients who did not meet their primary outcomes were censored at their last follow up.

Results

Twenty-nine HIV-infected patients (34% female, 66% black, 83% early corticosteroid withdrawal) underwent deceased (n=24) or living donor (n=5) kidney transplantation. Median (IQR) age was 54 years (50-59). CD4+ T-lymphocyte count was 455 (392-508). Graft and patient survival were 96.6% and 96.6% at 12 months respectively (Fig. 1).

At 12 months post-transplantation, acute rejection-free survival was 96.4% and infection-free survival was 55.2%. Sustained HIV viral suppression was observed in 69% of patients. Ten patients (34%) developed 11 malignancies during their follow up.

Conclusion

Induction immunosuppression with anti-thymocyte globulin is associated with excellent clinical outcomes in HIV-infected kidney allograft recipients.

Figure 1. Kaplan-Meier graft (Left) and patient survival (Right) estimates of 29 HIV-infected kidney recipients at our center managed with Thymoglobulin induction immunosuppression.