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Impact of Protease Inhibitor based Anti-Retroviral Therapy on Outcomes for HIV+ Kidney Transplant Recipients.

Impact of Protease Inhibitor based Anti-Retroviral Therapy on Outcomes for HIV+ Kidney Transplant Recipients.
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Sawinski D, Shelton BA, Mehta S, Reed RD, MacLennan PA, Gustafson S, Segev DL, Locke JE,


Sawinski D, Shelton BA, Mehta S, Reed RD, MacLennan PA, Gustafson S, Segev DL, Locke JE, (click to view)

Sawinski D, Shelton BA, Mehta S, Reed RD, MacLennan PA, Gustafson S, Segev DL, Locke JE,

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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

Abstract

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.

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