Abstract: SA-PO993
Survival of Kidney Transplantation in People Living with HIV/AIDS: A Systematic Review and Meta-Analysis
Session Information
- Transplantation: Clinical - 4
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Leung, Ka chun, Tuen Mun Hospital Department of Medicine and Geriatrics, Hong Kong, Hong Kong
- Ng, Wincy Wing Sze, Queen Mary Hospital, Hong Kong, Hong Kong
Background
As of 2022, nearly 40 million individuals are affected by HIV/AIDS, with 1.3 million new cases annually. The high effectiveness of antiretroviral therapy (ART) has made kidney transplantation a possibility for people living with HIV/AIDS (PLWHA) who are suffering from chronic kidney disease (CKD). The HIV Organ Policy Equity (HOPE) Act in the US lead to research in different aspects of transplant complexities including drug interactions and co-infections. This review aimed to evaluate kidney transplantation outcomes in PLWHA.
Methods
Databases were searched up to Nov 2023. Prospective and retrospective clinical trials were included. Primary outcomes centered on graft survival(GS), rejection(GR), infections, and patient survival(PS) post-transplantation. Secondary outcomes assessed the impact of ART and co-infections.
Results
601 potentially eligible studies were identified with 48 included in analysis. No significant survival disadvantage for PLWHA in short term survival despite a higher long term risk (1yr PS 94%, hazard ratio(HR) 1.43, p=0.077; >5yr PS 83%, HR 1.91, p=0.005; 1yr GS 90%; >5yr GS 71%)(Table1, Figure1). There are positive impact of integrase inhibitor-containing ART regimens on PS and GS.
Conclusion
Kidney transplantation is an effective option for PLWHA, with outcomes comparable to the general population. Research on long-term outcomes, newer ART regimens, and tailored post-transplant monitoring protocols for PLWHA are essential to improve patient outcomes.
Table 1. Primary outcome
| Time Frame (years) | Outcome(%)[95%CI] | Hazard Ratio[95%CI] | I2(%) | p | |
| Patient Survival | 1 | 93.90[92.8–94.9] | 1.43[0.96–2.11] | 97.04 | 0.077 |
| 3 | 89.50[87.3–91.5] | 1.09[0.81–1.47] | 92.81 | 0.585 | |
| >5 | 82.80[76.6–87.7] | 1.91[1.22–2.99] | 93.94 | 0.005 | |
| Graft Survival | 1 | 90.20[88.8–91.5] | 2.11[1.50–2.95] | 95.34 | <0.0001 |
| 3 | 77.90[72.7–82.3] | 1.89[1.14–3.15] | 97.62 | 0.014 | |
| >5 | 70.60[64.3–76.2] | 1.76[0.87–3.59] | 97.29 | 0.118 | |
| Graft Rejection | 1 | 25.90[18.7–34.8] | 0.71[0.61–0.84] | 72.84 | 0.005 |
| 3 | 32.70[22.9–44.2] | ||||
| >5 | 38.50[28.3–49.9] | 0.62[0.46–0.84] | 82.75 | 0.002 |
I2 and p are the heterogeneity assessment of hazard ratio data synthesis