2024/11/06 by Rasha El‐Rifai, Kaushik Bhunia, Lauren Fontana +4 · 1 voice
Medicine · #HIV/AIDS drug development and treatment #Renal Transplantation Outcomes and Treatments #Pneumocystis jirovecii pneumonia detection and treatment
paper · pdf · doi:10.1016/j.ajt.2024.11.004
openalex publication_date 2024/11/06 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/22
We analyzed the Scientific Registry of Transplant Recipients (2004-2022) for primary kidney transplant recipients with HIV who had average immunologic risk and were discharged on tacrolimus/mycophenolate mofetil (with or without corticosteroids). Recipients were grouped by induction type: rabbit antithymocyte globulin (r-ATG, n = 688) and human interleukin-2 receptor antagonist (IL2Ra, n = 467). Kaplan-Meier curves were generated to examine recipient and graft survival by induction type. We used mixed Cox proportional hazard models to determine associations between induction type and outcomes of interest, with adjustments for recipient and donor factors and transplant center as a random effect. Regression with propensity score weighting reduced selection bias from nonrandom induction allocation. The unadjusted 10-year survival rate was 57% for those receiving r-ATG and 64% for those receiving IL2Ra (P < .001). Adjusted risk of death was significantly lower for IL2Ra induction than r-ATG induction with Cox multivariable (hazard ratio, 0.65; 95% CI, 0.47-0.91; P = .01) and inverse probability treatment weighting (hazard ratio, 0.38; 95% CI, 0.29-0.50; P < .01) models. Death-censored kidney graft survival did not differ by induction type in either model. The 1-year rejection rate was 10.1% and 11.6% for r-ATG and IL2Ra recipients, respectively (P = .52). Overall, IL2Ra conferred better long-term survival than r-ATG without increased risk of graft loss.