B368 - Infection-Related Hospitalizations After Kidney Transplant in People with Human Immunodeficiency Virus: Single Center Experience

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Author Block: A. Dang, M. Badowski, E. Drwiega, A. Elmasri, W. Dabbas, I. Y. Tang, M. Campara, University of Illinois at Chicago, Chicago, IL
*Purpose: Antiretroviral therapies have reduced the incidence of HIV-associated nephropathy in the US, but the rate of end stage kidney disease is on the rise in this population. Limited data is available to demonstrate infectious outcomes following kidney transplantation in People with Human Immunodeficiency Virus (PWH).
*Methods: This is a single-center, retrospective analysis of PWH who underwent kidney transplant (KTx) from 2014-2024 at a large, urban program. Variables across pre-, peri-, and post-transplant phases of care were examined in relationship to infectious complications and key transplant clinical outcomes.
*Results: Twenty-five PWH were identified for analysis. Cohort consisted of predominantly male 16 (64%), Black 21 (84%) KTx recipients with mean age of 48.8+/-11.6 years, Table 1. The primary cause of end stage kidney disease was hypertensive nephrosclerosis 14 (56%). Most patients 18 (72%) received a deceased donor KTx, with Thymoglobulin induction 23 (92%) and tacrolimus/mycophenolate 23 (92%). At evaluation, 7 (28%) patients were on protease inhibitor-based antiretroviral therapy; all transitioned to integrase strand transfer inhibitor (INSTI) based regimen by KTx, and remained on INSTIs at 1 year follow up. At the time of transplant, 24 (96%) patients had CD4 count > 200 cells/mm3 but all had HIV viral load < 50 copies/ml. Over 1-year follow up, 9 (36%) patients required hospitalization for a total of 10 infections. Majority of infections 8/10 (80%) occurred in the first 6 months post-KTx, with urinary tract infection being the most common, Table 2. One patient at high risk for CMV developed CMV viremia requiring hospitalization. Mean infection-related readmission length of stay was 8+/-7 days. At 1-year post-KTx, only 12 (48%) patients had their CD4 count and viral load checked; 3/12 (25%) having CD4 count <200 cells/mm3.
*Conclusions: Infection related admissions were observed in 36% of PWH undergoing KTx within first post-transplant year. Infection associated admissions had no impact on allograft function and patient survival at 1-year. However, close surveillance of HIV viral load and CD4 counts is warranted after transplantation.