Beyond Immunity: Challenges in Kidney Retransplantation Among Persons Living With HIV.

Area of Science:

• Nephrology
• Immunology
• Transplantation Science

Background:

• Kidney retransplantation (re-KT) is essential for patients with graft failure.
• While outcomes in HIV-positive (HIV+) individuals have improved, graft failure and the need for re-KT remain a concern.
• Understanding re-KT success rates in the current era is critical for optimizing patient care.

Purpose of the Study:

• To compare kidney allograft survival rates between HIV-positive and HIV-negative populations undergoing re-KT.
• To identify risk factors associated with graft loss in kidney retransplantation.
• To evaluate the impact of human immunodeficiency virus status on re-KT outcomes.

Main Methods:

• Utilized data from the Organ Procurement and Transplantation Network (OPTN) for first kidney re-KTs between 2014-2022.
• Employed Kaplan-Meier analysis and log-rank tests to assess allograft survival.
• Applied Cox proportional hazards models to identify risk factors for graft loss.

Main Results:

• HIV+ recipients had higher rates of Black ethnicity, HLA mismatch >3, delayed graft function, and graft loss from primary nonfunction.
• HIV- recipients were more likely to be White/Hispanic, experience acute rejection, and receive living donor kidneys.
• HIV+ status increased graft loss risk by 1.68-fold; delayed graft function by 1.89-fold; HLA mismatch >3 by 1.18-fold. Living donors decreased risk by 15.8%.

Conclusions:

• Disproportionate graft failure and inadequate HLA matching persist in the HIV+ re-KT population.
• There is a significant disparity in kidney allograft survival between HIV+ and HIV- individuals undergoing re-KT.
• Enhanced organ matching strategies and desensitization protocols are vital for improving re-KT outcomes in HIV+ patients.