Association of tenofovir disoproxil fumarate with primary allograft survival in HIV-positive kidney transplant recipients

Background Tenofovir disoproxil fumarate (TDF) is an anti-retroviral agent frequently used to treat human immunodeficiency virus (HIV). There are concerns regarding its potential to cause acute kidney injury, chronic kidney disease, and proximal tubulopathy. Although TDF can effectively suppress HIV after kidney transplantation, it is unknown whether use of TDF-based anti-retroviral therapy (ART) after kidney transplant (KT) adversely affects allograft survival. Methods We examined 104 HIV+ KT recipients at our center between 2001 and 2014. We generated a propensity-score for TDF treatment using recipient and donor characteristics. We then fit Cox proportional hazards models to investigate the association between TDF-treatment and 3-year, death-censored primary allograft failure, adjusting for the propensity score and delayed graft function (DGF). Results Of the 104 HIV+ KT candidates who received transplant during the study period, 23 (22%) were maintained on TDF-based ART at the time of transplant and 81 (78%), on non-TDF-based ART. Median age of the cohort was 48 years-old; 87% were male; 88%, black; and median CD4 count at transplant was 450 cells/mm3. Median kidney donor risk index was 1.2. At 3 years post transplant, primary allograft failure occurred in 26% of patients on TDF-based ART and 28% of patients on non-TDF-based ART (P-value 0.5). TDF treatment was not associated with primary allograft failure at 3 years post transplant after adjusting for DGF and a propensity score for TDF use (hazard ratio 2.12, 95% confidence interval 0.41-10.9). Conclusions In a large single-center experience of HIV+ kidney transplantation, TDF use following KT was not significantly associated with primary allograft failure. These results may help inform management for HIV+ kidney recipients in need of TDF therapy for adequate viral suppression. This article is protected by copyright. All rights reserved.