Survival Benefit of Kidney Transplantation in HIV-infected Patients

Ann Surg. 2017 Mar;265(3):604-608. doi: 10.1097/SLA.0000000000001761.


Objective: To determine the survival benefit of kidney transplantation in human immunodeficiency virus (HIV)-infected patients with end-stage renal disease (ESRD).

Summary background data: Although kidney transplantation (KT) has emerged as a viable option for select HIV-infected patients, concerns have been raised that risks of KT in HIV-infected patients are higher than those in their HIV-negative counterparts. Despite these increased risks, KT may provide survival benefit for the HIV-infected patient with ESRD, yet this important clinical question remains unanswered.

Methods: Data from the Scientific Registry of Transplant Recipients were linked to IMS pharmacy fills (January 1, 2001 to October 1, 2012) to identify and study 1431 HIV-infected KT candidates from the first point of active status on the waiting list. Time-dependent Cox regression was used to establish a counterfactual framework for estimating survival benefit of KT.

Results: Adjusted relative risk (aRR) of mortality at 5 years was 79% lower after KT compared with dialysis (aRR 0.21; 95% CI 0.10-0.42; P <0.001), and statistically significant survival benefit was achieved by 194 days of KT. Among patients coinfected with hepatitis C, aRR of mortality at 5 years was 91% lower after KT compared with dialysis (aRR 0.09; 95% CI 0.02-0.46; P < 0.004); however, statistically significant survival benefit was not achieved until 392 days after KT.

Conclusions: Evidence suggests that for HIV-infected ESRD patients, KT is associated with a significant survival benefit compared with remaining on dialysis.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Comorbidity
  • Female
  • Graft Rejection
  • Graft Survival
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • HIV Infections / surgery
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / epidemiology*
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / methods*
  • Kidney Transplantation / mortality
  • Living Donors
  • Male
  • Middle Aged
  • Patient Selection
  • Prognosis
  • Registries*
  • Renal Dialysis / methods
  • Renal Dialysis / mortality
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Tissue Donors*
  • Treatment Outcome
  • United States
  • Young Adult