The Association of Pretransplant CD4 Count With Post-Kidney Transplant Infectious Outcomes Among Persons With HIV.

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) between groups. CONCLUSION: These findings suggest that pretransplant CD4 count alone may not reflect the true risk of post-KT infection in PWH.