TY - JOUR
T1 - Early steroid withdrawal in HIV-infected kidney transplant recipients
T2 - Utilization and outcomes
AU - Werbel, William A.
AU - Bae, Sunjae
AU - Yu, Sile
AU - Al Ammary, Fawaz
AU - Segev, Dorry L.
AU - Durand, Christine M.
N1 - Funding Information:
This work was supported by Grant T32AI007291 to Dr Werbel (National Institutes of Health), K24DK101828 (National Institute of Diabetes and Digestive and Kidney Diseases) to Dr Segev, and K23CA177321 to Dr Durand (National Cancer Institute). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US government.
Funding Information:
This work was supported by Grant T32AI007291 to Dr Werbel (National Institutes of Health), K24DK101828 (National Institute of Diabetes and Digestive and Kidney Diseases) to Dr Segev, and K23CA177321 to Dr Durand (National Cancer Institute). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US government.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/2
Y1 - 2021/2
N2 - Kidney transplant (KT) outcomes for HIV-infected (HIV+) persons are excellent, yet acute rejection (AR) is common and optimal immunosuppressive regimens remain unclear. Early steroid withdrawal (ESW) is associated with AR in other populations, but its utilization and impact are unknown in HIV+ KT. Using SRTR, we identified 1225 HIV+ KT recipients between January 1, 2000, and December 31, 2017, without AR, graft failure, or mortality during KT admission, and compared those with ESW with those with steroid continuation (SC). We quantified associations between ESW and AR using multivariable logistic regression and interval-censored survival analysis, as well as with graft failure and mortality using Cox regression, adjusting for donor, recipient, and immunologic factors. ESW utilization was 20.4%, with more zero HLA mismatch (8% vs 4%), living donors (26% vs 20%), and lymphodepleting induction (64% vs 46%) compared to the SC group. ESW utilization varied widely across 129 centers, with less use at high- versus moderate-volume centers (6% vs 21%, P <.001). AR was more common with ESW by 1 year (18.4% vs 12.3%; aOR: 1.081.612.41, P =.04) and over the study period (aHR: 1.021.391.90, P =.03), without difference in death-censored graft failure (aHR 0.600.911.36, P =.33) or mortality (aHR: 0.751.151.77, P =.45). To reduce AR after HIV+ KT, tailoring of ESW utilization is reasonable.
AB - Kidney transplant (KT) outcomes for HIV-infected (HIV+) persons are excellent, yet acute rejection (AR) is common and optimal immunosuppressive regimens remain unclear. Early steroid withdrawal (ESW) is associated with AR in other populations, but its utilization and impact are unknown in HIV+ KT. Using SRTR, we identified 1225 HIV+ KT recipients between January 1, 2000, and December 31, 2017, without AR, graft failure, or mortality during KT admission, and compared those with ESW with those with steroid continuation (SC). We quantified associations between ESW and AR using multivariable logistic regression and interval-censored survival analysis, as well as with graft failure and mortality using Cox regression, adjusting for donor, recipient, and immunologic factors. ESW utilization was 20.4%, with more zero HLA mismatch (8% vs 4%), living donors (26% vs 20%), and lymphodepleting induction (64% vs 46%) compared to the SC group. ESW utilization varied widely across 129 centers, with less use at high- versus moderate-volume centers (6% vs 21%, P <.001). AR was more common with ESW by 1 year (18.4% vs 12.3%; aOR: 1.081.612.41, P =.04) and over the study period (aHR: 1.021.391.90, P =.03), without difference in death-censored graft failure (aHR 0.600.911.36, P =.33) or mortality (aHR: 0.751.151.77, P =.45). To reduce AR after HIV+ KT, tailoring of ESW utilization is reasonable.
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - clinical research/practice
KW - immunosuppressant – steroid
KW - immunosuppression/immune modulation
KW - immunosuppressive regimens – minimization/withdrawal
KW - infection and infectious agents – viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
KW - infectious disease
KW - kidney transplantation/nephrology
KW - rejection: acute
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U2 - 10.1111/ajt.16195
DO - 10.1111/ajt.16195
M3 - Article
C2 - 32681603
AN - SCOPUS:85089374355
SN - 1600-6135
VL - 21
SP - 717
EP - 726
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 2
ER -