Infections After Kidney Transplantation From Donors With HIV to Recipients With HIV

Area of Science:

• Nephrology
• Infectious Diseases
• Transplantation Immunology

Background:

• Kidney transplantation (KT) from human immunodeficiency virus (HIV)-positive donors to HIV-positive recipients (HIV D+/R+) is safe compared to KT from HIV-negative donors (HIV D-/R+).
• Potential differences in post-transplant infections require further investigation.

Purpose of the Study:

• To compare the incidence and timing of clinically relevant infections after KT in HIV D+/R+ versus HIV D-/R+ recipients.

Main Methods:

• Secondary analysis of the HOPE in Action KT Study (NCT02602262).
• Comparison of time to first clinically relevant infection within 24 months post-transplantation in 99 HIV D+/R+ and 99 HIV D-/R+ recipients.
• Outcomes included infection incidence rates, infection-related death, and infection timing, stratified by donor HIV status.

Main Results:

• Cumulative incidence of clinically relevant infection at 24 months was 73.8% in HIV D+/R+ versus 64.7% in HIV D-/R+ recipients.
• The adjusted hazard ratio for time to first clinically relevant infection was 1.44 (95% CI: 1.01-2.04) in HIV D+/R+ versus HIV D-/R+ recipients.
• No significant differences were observed in infections requiring hospitalization, number of infections, death from infection, or infection characteristics, although viral infections were numerically more common in HIV D+/R+ recipients.

Conclusions:

• A statistically significant association exists between HIV-positive donor kidneys and time to first clinically relevant infection within 24 months post-transplantation.
• No significant differences in hospitalization-associated infections were found, suggesting overall reassurance for this practice.
• These findings support the expansion of HIV-positive donor kidney transplantation into clinical care.