P-455. Post-Transplantation Infection and Rejection Outcomes in Kidney Transplant Recipients Living with Human Immunodeficiency Virus (HIV): A Single-Center Experience Over a Decade of Evolving Practices

Abstract Background The development of integrase inhibitor and injectable antiretroviral therapy (ART), use of lymphocyte-depleting induction, and implementation of the HIV Organ Policy Equity (HOPE) Act have revolutionized kidney transplant eligibility, peri-transplantation management, and post-transplantation outcomes for people living with HIV and advanced kidney disease in the last decade. We describe our experience with HIV-positive recipients over this important period. Methods We conducted a retrospective chart review of all adults living with HIV and advanced kidney disease who underwent kidney transplantation at our center between 2013-2024. Data was collected on demographics, ART and induction regimens, and post-transplantation outcomes: patient/allograft survival, infections, and rejection episodes within the first year. Results Sixteen patients (14 Male, 13 Black, Mean Age 51y) underwent 17 kidney transplantations. Ten transplantations occurred from 2013-2022; seven occurred within 18 months of our center’s implementation of the HOPE Act. HIV-associated nephropathy accounted for all six transplantations from 2013-2017; hypertension and diabetes mellitus accounted for most transplantations in later years. Four patients transplanted prior to 2017 received basiliximab, of whom one experienced rejection within a year; 13 subsequent transplantations were induced with anti-thymocyte globulin (ATG), with three complicated by rejection. Rejection incidence was comparable between recipients of 3 mg/kg and 4.5 mg/kg ATG. Two patients suffered graft loss (rejection, BK nephropathy). Eleven patients had infections within a year, predominantly urinary tract infections and cytomegalovirus viremia. No opportunistic infections were identified. Three out of the four patient deaths in this cohort were due to complications of coronavirus disease 2019. Conclusion Recent advancements in HIV care and solid organ transplantation practices converged to facilitate pre-transplantation optimization, increase opportunities for transplantation, and improve post-transplantation outcomes for people living with HIV and advanced kidney disease. When used with integrase inhibitor-based therapy, ATG can prevent rejection without precipitating opportunistic infections. Disclosures All Authors: No reported disclosures