Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors.

Muzaale AD, Althoff KN, Sperati CJ, Abraham AG, Kucirka LM, Massie AB, Kitahata MM, Horberg MA, Justice AC, Fischer MJ, Silverberg MJ, Butt AA, Boswell SL, Rachlis AR, Mayor AM, Gill MJ, Eron JJ, Napravnik S, Drozd DR, Martin JN, Bosch RJ, Durand CM, Locke JE, Moore RD, Lucas GM, Segev DL. Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2017 Jul 1; 17(7):1823-1832.

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Abstract:

New federal regulations allow HIV-positive individuals to be live kidney donors; however, potential candidacy for donation is poorly understood given the increased risk of end-stage renal disease (ESRD) associated with HIV infection. To better understand this risk, we compared the incidence of ESRD among 41 968 HIV-positive participants of North America AIDS Cohort Collaboration on Research and Design followed for a median of 5 years with the incidence of ESRD among comparable HIV-negative participants of National Health and Nutrition Examination III followed for a median of 14 years. We used risk associations from multivariable Cox proportional hazards regression to derive cumulative incidence estimates for selected HIV-positive scenarios (no history of diabetes, hypertension, AIDS, or hepatitis C virus coinfection) and compared these estimates with those from similarly selected HIV-negative scenarios. For 40-year-old HIV-positive individuals with health characteristics that were similar to those of age-matched kidney donors, viral load < 400 copies/mL, and CD4 count = 500 cells/µL, the 9-year cumulative incidence of ESRD was higher than that of their HIV-negative peers, yet still low: 2.5 versus 1.1 per 10 000 among white women, 3.0 versus 1.3 per 10 000 among white men, 13.2 versus 3.6 per 10 000 among black women, and 15.8 versus 4.4 per 10 000 among black men. HIV-positive individuals with no comorbidities and well-controlled disease may be considered low-risk kidney donor candidates.