CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

CI: 2.9, 13.7). Diabetes (OR 2.32, 95%CI 1.0, 5.5) and proteinuria (OR 1.66, 95%CI 1.1, 2.6) predicted a steeper slope of eGFR decline. Neither current nor cumulative tenofovir use was associated with progression to CKD (current TDF HR 0.69, 95% CI: 0.36, 1.33; cumulative TDF HR 0.88, 95% CI: 0.45, 1.7). Both the Short D:A:D and Scherzer scores were well calibrated but the Short D:A:D score had better discrimination (D:A:D AUROC 0.84, Scherzer AUROC 0.76, p=0.04). Conclusion: Individuals with a lower baseline eGFR are at higher risk for CKD. Risk prediction tools may be useful in identifying those at greatest risk who may benefit from aggressive management of risk factors, specifically diabetes and proteinuria.

Poster and Themed Discussion Abstracts

688 KIDNEY TRANSPLANT OUTCOMES IN HIV-POSITIVE AND HIV-NEGATIVE RECIPIENT PAIRS Esther Gathogo 1 , Frank Post 2 1 King’s Coll London, London, UK, 2 King’s Coll Hosp NHS Fndn Trust, London, UK

Background: HIV infection is a risk factor for end-stage kidney disease, and kidney transplantation has been successfully employed in HIV positive patients. Several studies have shown that HIV positive kidney transplant recipients are at increased risk of acute allograft rejection although the aetiology for this remains poorly defined. We examined allograft outcomes in HIV positive and HIV negative recipient pairs who each received a kidney from a deceased donor. Methods: Data from a national cohort study of HIV positive kidney transplant recipients (2005-2013) were linked to the national kidney transplant registry (NHSBT). HIV sero- discordant recipients of deceased donor allografts during this period were identified. Donor characteristics and clinical outcomes in HIV+ and HIV- recipients were compared. Kaplan-Meier methods were used to estimate host/graft survival and cumulative incidence of allograft rejection. Logrank tests were used to compare survival and Cox- proportional hazard regression analysis to identify factors associated with acute graft rejection. Results: Forty HIV sero-discordant kidney allograft recipient pairs were identified. HIV+ recipients were younger (43.5 vs. 52.0 years, p=0.009) and more often of black ethnicity (75% vs. 13%, p<0.001). Cold ischaemia time (15.0 vs. 14.8 hours, p=0.44), degree of HLA mismatch (1-2 mismatches: 43% vs. 48%, p=0.38) and incidence of delayed graft function (32% vs. 26%, p=0.51) were similar. HIV+ recipients were less likely to receive tacrolimus (49% vs. 86%, p=0.001) as part of their initial immunosuppressive regimen, and more likely to experience acute graft rejection in the first year post transplantation (45% vs. 35%, p=0.04). At 3 years, overall patient survival was similar (91% vs. 90%, p=0.93) but graft survival was less favourable (84% vs. 100%, p=0.02). HIV status, ethnicity and HLA mismatch were associated with acute graft rejection in univariable analysis. After adjustment, HIV status was no longer associated with allograft rejection (Table). Conclusion: HIV positive kidney allograft recipients experienced higher rates of acute rejection than HIV negative recipients. However, adjustment for differences in recipient ethnicity and HLA mismatch attenuated the association between HIV infection and acute graft rejection.

CROI 2017 300