J.F. Suarez, R. Rosa, M.A. Lorio, M.I. Morris, L.M. Abbo, J. Simkins, G. Guerra, D. Roth, W.L. Kupin, A. Mattiazzi, G. Ciancio, L.J. Chen, G.W. Burke, M.J. Goldstein, P. Ruiz, J.F. Camargo

In current practice HIV(+) candidates with CD4 >200 cells/mm(3) are eligible for kidney transplantation. However, the optimal pre-transplant CD4 count above this threshold remains to be defined. We evaluated clinical outcomes in patients with baseline CD4 >350 and <350 cells/mm(3) among 38 anti-thymocyte globulin (ATG)-treated HIV(-) to HIV(+) kidney transplants performed at our center between 2006 and 2013. Median follow-up was 2.6 years. Rates of acute rejection, patient and graft survival were not different between groups. However, occurrence of severe CD4 lymphopenia (<200 cells/mm(3) ) was more common among individuals with a baseline CD4 count 200-349 cells/mm(3) compared to those transplanted at higher counts (75% vs 30% at 4 weeks [p=0.04] and 71% vs 5% at 52 weeks [p=0.001] post-transplant, respectively). After adjusting for age, baseline CD4 count of 200-349 cells/mm(3) was an independent predictor of severe CD4 lymphopenia at 4 (RR, 2.6; 95% CI, 1.3-5.1) and 52 weeks (RR, 14.3; 95% CI, 2-100.4) post-transplant. Patients with CD4 <200 cells/mm(3) at 4 weeks had higher probability of serious infections during first 6 months post-transplant (19% vs. 50%; log-rank 0.05). These findings suggest that ATG must be used with caution in HIV(+) kidney allograft recipients with a pre-transplant CD4 count <350 cells/mm(3) . This article is protected by copyright. All rights reserved.