Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients

J. E. Locke, R. D. Reed, S. G. Mehta, C. Durand, R. B. Mannon, P. Maclennan, B. Shelton, Michelle Martin, H. Qu, R. Shewchuk, D. L. Segev

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Abstract

Excellent outcomes among HIV+ kidney transplant (KT) recipients have been reported by the NIH consortium, but it is unclear if experience with HIV+ KT is required to achieve these outcomes. We studied associations between experience measures and outcomes in 499 HIV+ recipients (SRTR data 2004-2011). Experience measures examined included: (1) center-level participation in the NIH consortium; (2) KT experiential learning curve; and (3) transplant era (2004-2007 vs. 2008-2011). There was no difference in outcomes among centers early in their experience (first 5 HIV+ KT) compared to centers having performed >6 HIV+ KT (GS adjusted hazard ratio [aHR]: 1.05, 95% CI: 0.68-1.61, p = 0.82; PS aHR: 0.93; 95% CI: 0.56-1.53, p = 0.76), and participation in the NIH-study was not associated with any better outcomes (GS aHR: 1.08, 95% CI: 0.71-1.65, p = 0.71; PS aHR: 1.13; 95% CI: 0.68-1.89, p = 0.63). Transplant era was strongly associated with outcomes; HIV+ KTs performed in 2008-2011 had 38% lower risk of graft loss (aHR: 0.62; 95% CI: 0.42-0.92, p = 0.02) and 41% lower risk of death (aHR: 0.59; 95% CI: 0.39-0.90, p = 0.01) than that in 2004-2007. Outcomes after HIV+ KT have improved over time, but center-level experience or consortium participation is not necessary to achieve excellent outcomes, supporting continued expansion of HIV+ KT in the US.

Original languageEnglish (US)
Pages (from-to)2096-2104
Number of pages9
JournalAmerican Journal of Transplantation
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2015

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HIV
Transplants
Kidney
Problem-Based Learning
Learning Curve
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Locke, J. E., Reed, R. D., Mehta, S. G., Durand, C., Mannon, R. B., Maclennan, P., ... Segev, D. L. (2015). Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients. American Journal of Transplantation, 15(8), 2096-2104. https://doi.org/10.1111/ajt.13220

Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients. / Locke, J. E.; Reed, R. D.; Mehta, S. G.; Durand, C.; Mannon, R. B.; Maclennan, P.; Shelton, B.; Martin, Michelle; Qu, H.; Shewchuk, R.; Segev, D. L.

In: American Journal of Transplantation, Vol. 15, No. 8, 01.08.2015, p. 2096-2104.

Research output: Contribution to journalArticle

Locke, JE, Reed, RD, Mehta, SG, Durand, C, Mannon, RB, Maclennan, P, Shelton, B, Martin, M, Qu, H, Shewchuk, R & Segev, DL 2015, 'Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients', American Journal of Transplantation, vol. 15, no. 8, pp. 2096-2104. https://doi.org/10.1111/ajt.13220
Locke JE, Reed RD, Mehta SG, Durand C, Mannon RB, Maclennan P et al. Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients. American Journal of Transplantation. 2015 Aug 1;15(8):2096-2104. https://doi.org/10.1111/ajt.13220
Locke, J. E. ; Reed, R. D. ; Mehta, S. G. ; Durand, C. ; Mannon, R. B. ; Maclennan, P. ; Shelton, B. ; Martin, Michelle ; Qu, H. ; Shewchuk, R. ; Segev, D. L. / Center-Level Experience and Kidney Transplant Outcomes in HIV-Infected Recipients. In: American Journal of Transplantation. 2015 ; Vol. 15, No. 8. pp. 2096-2104.
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abstract = "Excellent outcomes among HIV+ kidney transplant (KT) recipients have been reported by the NIH consortium, but it is unclear if experience with HIV+ KT is required to achieve these outcomes. We studied associations between experience measures and outcomes in 499 HIV+ recipients (SRTR data 2004-2011). Experience measures examined included: (1) center-level participation in the NIH consortium; (2) KT experiential learning curve; and (3) transplant era (2004-2007 vs. 2008-2011). There was no difference in outcomes among centers early in their experience (first 5 HIV+ KT) compared to centers having performed >6 HIV+ KT (GS adjusted hazard ratio [aHR]: 1.05, 95{\%} CI: 0.68-1.61, p = 0.82; PS aHR: 0.93; 95{\%} CI: 0.56-1.53, p = 0.76), and participation in the NIH-study was not associated with any better outcomes (GS aHR: 1.08, 95{\%} CI: 0.71-1.65, p = 0.71; PS aHR: 1.13; 95{\%} CI: 0.68-1.89, p = 0.63). Transplant era was strongly associated with outcomes; HIV+ KTs performed in 2008-2011 had 38{\%} lower risk of graft loss (aHR: 0.62; 95{\%} CI: 0.42-0.92, p = 0.02) and 41{\%} lower risk of death (aHR: 0.59; 95{\%} CI: 0.39-0.90, p = 0.01) than that in 2004-2007. Outcomes after HIV+ KT have improved over time, but center-level experience or consortium participation is not necessary to achieve excellent outcomes, supporting continued expansion of HIV+ KT in the US.",
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