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. 2022 Feb;24(1):e13767.
doi: 10.1111/tid.13767. Epub 2021 Dec 14.

Early steps to kidney transplantation among persons with HIV and end-stage renal disease in ESRD network 6

Ruth O Adekunle  1 , Aneesh K Mehta  2   3 , Zhengsheng Wang  3 , Rachel E Patzer  3 , Rebecca Zhang  4
Affiliations

Early steps to kidney transplantation among persons with HIV and end-stage renal disease in ESRD network 6

Ruth O Adekunle et al. Transpl Infect Dis. 2022 Feb.

Abstract

Introduction: End-stage renal disease is a significant cause of morbidity and mortality in persons with HIV (PWH). Limited data exist on access to kidney transplantation for this population.

Methods: A dataset inclusive of incident dialysis patients between 2012 and 2016 with follow-up through December 2017 that identifies PWH and the general dialysis population of Network 6 (Georgia, North Carolina, South Carolina) was created through merging the United States Renal Data System with the southeastern early transplant access registry. Early steps to kidney transplantation and patient and dialysis facility-level characteristics that serve as barriers to transplantation were described.

Results: Twenty-three thousand four hundred fourteen patients were identified; 469 were PWH. Compared to non-HIV individuals, PWH were younger (49 vs. 58 years, p < 0.001), predominantly Black (87% vs. 56% p < 0.001) and male (72% vs. 56% p < 0.001). PWH were less likely to be referred to kidney transplant within 1 year of starting dialysis (36% vs. 41% p < 0.001) and waitlisted within 1 year of evaluation-start (14% vs. 30%, p = 0.05). PWH (vs. non-PWH) waited longer for referral, evaluation-start, and waitlisting and in multivariable analysis; HIV positivity was associated with a lower probability of referral (hazard ratios [HR]: 0.70; 95% confidence intervals [CIs]: 0.62-0.80), evaluation (HR 0.66; 95% CI: 0.55-0.80), and waitlisting (HR 0.29; 95% CI: 0.20-0.41).

Conclusions: Targeted interventions are needed to improve access to kidney transplants, particularly in waitlisting, for PWH.

Keywords: access to transplant; disparities; kidney transplant; persons with HIV.

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Conflict of interest statement

Disclosures

The authors of this manuscript have no conflicts of interest to disclose as described by The authors of this manuscript have no conflicts of interest to disclose as described by Transplant Infectious Diseases.

Figures

Figure 1.
Figure 1.
Study cohort flowchart for incident patients with ESRD in ESRD Network 6: 2012–2016, with follow-up through 12/31/2017.
Figure 2a-c.
Figure 2a-c.
Cumulative incidence of referral, evaluation, and waitlisting comparing PWH to HIV negative persons between 2012 and 2016 with follow up through 12/31/2017. A. Cumulative incidence of referral at 1 year was 41% (95% CI 0.40 – 0.42) for HIV negative persons and 36% (95% CI 0.32 – 0.40) for PWH. B. Cumulative incidence of evaluation at 6 months was 55% (95% CI 0.54 – 0.56) for HIV negative persons and 50% (95% CI 0.43 – 0.56) for PWH. C. Cumulative incidence of waitlisting at 1 year was 34% (95% CI 0.33 – 0.35) for HIV negative persons and 14% (95% CI 0.08 – 0.22) for PWH.
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