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

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Excellent outcomes have been reported for kidney transplant (KT) recipients with HIV (HIV+).
• The necessity of specialized center experience or NIH consortium participation for these outcomes remains unclear.
• Understanding factors influencing HIV+ KT success is crucial for expanding access to transplantation.

Purpose of the Study:

• To investigate the association between center experience and outcomes in HIV+ KT recipients.
• To determine if participation in the NIH consortium or transplant era influences outcomes.
• To assess the impact of the learning curve on graft survival and patient mortality.

Main Methods:

• Analysis of 499 HIV+ KT recipients from the SRTR database (2004-2011).
• Examination of experience measures: NIH consortium participation, KT learning curve (first 5 vs. >6 HIV+ KT), and transplant era (2004-2007 vs. 2008-2011).
• Statistical analysis using adjusted hazard ratios (aHR) for graft loss and death.

Main Results:

• No significant difference in outcomes between centers with early (<5) and experienced (>6) HIV+ KT volume.
• NIH consortium participation was not associated with improved graft survival or reduced mortality.
• HIV+ KTs performed during 2008-2011 showed significantly lower risks of graft loss (aHR: 0.62) and death (aHR: 0.59) compared to 2004-2007.

Conclusions:

• Center-level experience and NIH consortium involvement are not essential for achieving excellent HIV+ KT outcomes.
• Outcomes after HIV+ KT have substantially improved over time, independent of center-specific experience.
• These findings support the continued expansion of kidney transplantation for HIV+ individuals in the US.