2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Potential Etiologies for High Rates of Acute Rejection

1. Reluctance to use lymophocyte depleting agents



Median change in the CD4+ T- cell count from baseline to 1- year after transplantation was significantly greater in patients who received early induction therapy withantithymocyte globulin therapy HIVPositive (%) [n=516] 35.1 25.8 33.5 Patients who received antithymocyte globulin therapy in the first week had 2x as many serious infections per follow-up year (0.9 vs. 0.4, p=0.002) 9.3 83.7 7.0 5.6

HIVNegative (%) [n=93,027]

p-value

<0.001

Induction Immunosuppression

None

21.4 43.5 23.1 12.0

Anti-thymocyteglobulin

Anti-interleukin2

Alemtuzumab

Maintenance Immunosuppression

<0.001



Neither

5.0

Calcineurin Inhibitor-based

89.0

Sirolimus-based

6.1

StockPG,BarinB,Murphy B,et al. Outcomes from kidney transplantation inHIV-infected recipients. NEJM2010,363:2004-14. Locke JE,JamesN,Mehta S,etal. Induction immunosuppression and the riskof acute rejection inHIV-infected kidney transplant recipients. Transplantation 2014;97: 446-450.

Slide43of63FromJELocke,MD,MPHatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.

Lower Risk of Acute Rejection at 1-year with ATG Induction among HIV-infected Recipients

Locke JE,JamesN,Mehta S,etal. Induction immunosuppression and the riskof acute rejection in HIV-infected kidney transplant recipients. Transplantation 2014;97: 446-450.

Slide44of63FromJELocke,MD,MPHatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.

No Difference in Risk of Acute Rejection among ATG Induced HIV+ & HIV- Recipients

Anti-thymocyte InducedRecipients

Rejectionwithin1-year (RR)

95%Confidence Interval

p-value

reference

non-HIV infected

HIV-infected

1.16

0.41,3.31

0.77

 Matched Control analysis among HIV-infected and non-HIV infected anti- thymocyte globulin induced kidney transplant recipients

 Progressive radius matching (1:1) 

Donor Factors  type (living or deceased)  Recipient Factors  age, race PRA, number HLA mismatches, h/o previous transplant, HCV

Locke JE,JamesN,Mehta S,etal. Induction immunosuppression and the riskof acute rejection inHIV-infected kidney transplant recipients. Transplantation 2014;97:446-450. .

Slide45of63FromJELocke,MD,MPHatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.