American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2017 07 11() doi 10.1111/ajt.14419
Excellent outcomes have been demonstrated among select HIV-positive kidney transplant (KT) recipients with well-controlled infection, but to date no national study has explored outcomes among HIV+ KT recipients by antiretroviral therapy (ART) regimen. IMS pharmacy fills (1/1/01 – 10/1/12) were linked with SRTR data. 332 recipients with pre- and post-transplant fills were characterized by ART at time of transplant as protease inhibitor (PI) or non-PI based ART (88 PI vs. 244 non-PI). Cox proportional hazards models were adjusted for recipient and donor characteristics. Comparing recipients by ART regimen, there were no significant differences in age, race, or HCV status. Recipients on PI-based regimens were significantly more likely to have an estimated post-transplant score (EPTS) > 20% (70.9% vs. 56.3%, p=0.02) than those on non-PI regimens. On adjusted analyses, PI-based regimens were associated with 1.8-fold increased risk of allograft loss (aHR: 1.84, 95%CI: 1.22-2.77, p=0.003), with the greatest risk observed in the first post-transplant year (aHR: 4.48, 95%CI: 1.75-11.48, p=0.002), and 1.9-fold increased risk of death as compared to non-PI regimens (aHR: 1.91, 95%CI: 1.02-3.59, p=0.05). These results suggest whenever possible recipients should be converted to a non-PI regimen prior to KT. This article is protected by copyright. All rights reserved.