The Association of Pretransplant CD4 Count With Post‐Kidney Transplant Infectious Outcomes Among Persons With HIV
Rebecca H. Burns, Sara Booth, Christin Rogers Marks, Christine M. Durand, Jonathan Hand, Maheen Z. Abidi, Maricar Malinis, Brittany Barnaba, Martha Pavlakis, Douglas Krakower, Carolyn D. Alonso, Audrey Le‐MahajanABSTRACT
Background
Few studies have examined pretransplant CD4 count and risk of post‐kidney transplant (KT) infection in persons with HIV (PWH).
Methods
This multi‐center, retrospective cohort study included adult PWH undergoing KT from 2004 to 2019. The primary outcome was infection in the first year post‐KT in PWH with pretransplant CD4 < 350 cells/µL versus CD4 ≥ 350 cells/µL. Relative risk was assessed using modified Poisson modeling. Restricted mean survival time analysis was used to assess 5‐year posttransplant outcomes.
Results
Of the 75 patients included, 27% had a pretransplant CD4 < 350 cells/µL. Those with CD4 < 350 versus CD4 ≥ 350 were more likely to be hospitalized for infection in the first year (55% versus 16%, p = 0.001). There were no significant differences in relative risk of infection in the first‐year posttransplant (RR: 1.31, p = 0.053), 5‐year overall survival (87.5% vs. 93%, p = 0.49) or 5‐year graft loss (29.4% vs. 23.1%, p = 0.61) betweengroups.
Conclusion
These findings suggest that pretransplant CD4 count alone may not reflect the true risk of post‐KT infection in PWH.