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. 2017 Mar 7;12(3):467-475.
doi: 10.2215/CJN.07460716. Epub 2017 Feb 23.

Access to Kidney Transplantation among HIV-Infected Waitlist Candidates

Jayme E Locke  1 , Shikha Mehta  2 , Deirdre Sawinski  3 , Sally Gustafson  4 , Brittany A Shelton  1 , Rhiannon D Reed  1 , Paul MacLennan  1 , Charlotte Bolch  4 , Christine Durand  5 , Allan Massie  6 , Roslyn B Mannon  2 , Robert Gaston  2 , Michael Saag  2 , Turner Overton  2 , Dorry L Segev  6
Affiliations

Access to Kidney Transplantation among HIV-Infected Waitlist Candidates

Jayme E Locke et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Kidney transplantation among HIV-infected patients with ESRD confers a significant survival benefit over remaining on dialysis. Given the high mortality burden associated with dialysis, understanding access to kidney transplantation after waitlisting among HIV+ candidates is warranted.

Design, setting, participants, & measurements: Data from the Scientific Registry of Transplant Recipients were linked to Intercontinental Marketing Statistics pharmacy fills (January 1, 2001 to October 1, 2012) so that we could identify and study 1636 HIV+ (defined as having filled one or more antiretroviral medications unique to HIV treatment) and 72,297 HIV- kidney transplantation candidates.

Results: HIV+ waiting list candidates were more often young (<50 years old: 62.7% versus 37.6%; P<0.001), were more often men (75.2% versus 59.3%; P<0.001), were more often black (73.6% versus 27.9%; P<0.001), had longer time on dialysis (years: 2.5 versus 0.8; P<0.001), were more often coinfected with hepatitis C virus (9.0% versus 3.9%; P<0.001), and were less likely to remain active on the waiting list (37.7% versus 49.4%; P<0.001). Waitlist mortality among HIV+ candidates was similar compared with HIV- candidates (adjusted hazard ratio, 1.03; 95% confidence interval, 0.89 to 1.20; P=0.67). In contrast, likelihood of living donor kidney transplantation was 47% lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.44 to 0.64; P<0.001), and there was a trend toward lower likelihood of deceased donor kidney transplantation (adjusted hazard ratio, 0.87; 95% confidence interval, 0.74 to 1.01; P=0.07) compared with in HIV- candidates.

Conclusions: Our findings highlight the need for additional study to better understand disparities in access to kidney transplantation, particularly living donor kidney transplantation, among HIV+ kidney waitlist candidates.

Keywords: African Continental Ancestry Group; Coinfection; HIV; HIV Infections; HIV-1; Hepatitis C; Humans; Kidney Failure, Chronic; Living Donors; Male; end-stage renal disease; kidney transplantation; renal dialysis.

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Figures

Figure 1.
Figure 1.
Construction of HIV+ cohort. IMS, Intercontinental Marketing Statistics.
Figure 2.
Figure 2.
Construction of HIV− cohort. IMS, Intercontinental Marketing Statistics.
Figure 3.
Figure 3.
Cumulative incidence of waitlist outcomes. Removed from waitlist refers to those candidates who were delisted for reasons other than transplant, death, or deteriorating health, including refused transplant, medically unsuitable, improved condition, changed to kidney-pancreas listing, unable to contact, or other.
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References

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