The Impact of Recipient HIV Status on Kidney Transplant Outcomes in the United Kingdom: Have Previous Studies Overestimated Risk?

BACKGROUND

Despite increasing literature on kidney transplantation in people with HIV, studies have largely overlooked the confounding impact of ethnicity and socioeconomic deprivation. This study aimed to assess posttransplant outcomes in HIV-positive recipients, adjusting for these key factors.

METHODS

Population-cohort study of single kidney-alone transplants (2005-2022) using the UK Transplant Registry. The primary outcome was graft survival. Multivariable regression models evaluated the impact of recipient HIV status on transplant outcomes.

RESULTS

We included 30 013 recipients: 20 517 deceased-donor (200 HIV-positive recipients) and 9496 live-donor (44 HIV-positive recipients). Multivariable models revealed no significant differences in 5-y graft survival for HIV-positive versus negative recipients, in either deceased (adjusted hazard ratio = 0.93, 95% confidence interval 0.61-1.41, P  = 0.721) or live donor cohorts (adjusted hazard ratio = 1.02 [0.31-3.33]; P  = 0.973). Recipient HIV status was also not associated with patient survival or delayed graft function in either cohort. HIV-positive recipients were more likely to experience acute rejection within 12 mo (deceased adjusted odds ratio = 1.53 [0.94-2.50]; P  = 0.091 and live adjusted odds ratio = 3.43 [1.44-8.19]; P  = 0.006) and had marginally lower adjusted 12-mo estimated glomerular filtration rate. Crude 12-mo acute rejection rates for HIV-positive versus negative recipients were 24.8% versus 14.2% (deceased) and 37.5% versus 15.3% (live). For all posttransplant outcomes, removing adjustment for ethnicity and deprivation led to greater adjusted risk estimates for HIV-positive recipients.

CONCLUSIONS

HIV-positive recipients achieve excellent graft and patient survival, which are no different from HIV-negative recipients on adjusted analyses. Previous studies without ethnicity or socioeconomic-deprivation adjustment have likely overestimated the risks of recipient HIV-positive transplants. HIV-positive recipients with an indication for kidney transplantation should have equitable access to assessment, listing and offers for kidney transplantation.