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. 2024 Mar 1;108(3):759-767.
doi: 10.1097/TP.0000000000004857. Epub 2023 Nov 28.

Wait Time Advantage for Transplant Candidates With HIV Who Accept Kidneys From Donors With HIV Under the HOPE Act

Jennifer D Motter  1 , Sarah Hussain  2 , Diane M Brown  2 , Sander Florman  3 , Meenakshi M Rana  3 , Rachel Friedman-Moraco  4 , Alexander J Gilbert  5 , Peter Stock  6 , Shikha Mehta  7 , Sapna A Mehta  8 , Valentina Stosor  9 , Nahel Elias  10 , Marcus R Pereira  11 , Ghady Haidar  12 , Maricar Malinis  13 , Michele I Morris  14 , Jonathan Hand  15 , Saima Aslam  16 , Joanna M Schaenman  17 , John Baddley  18 , Catherine B Small  19 , David Wojciechowski  20 , Carlos A Q Santos  21 , Emily A Blumberg  22 , Jonah Odim  23 , Senu K Apewokin  24 , Emmanouil Giorgakis  25 , Mary Grace Bowring  26 , William A Werbel  2 , Niraj M Desai  26 , Aaron A R Tobian  2 , Dorry L Segev  1   27   28 , Allan B Massie  1   27 , Christine M Durand  2 ; HOPE in Action Investigators
Collaborators, Affiliations

Wait Time Advantage for Transplant Candidates With HIV Who Accept Kidneys From Donors With HIV Under the HOPE Act

Jennifer D Motter et al. Transplantation. .

Abstract

Background: Kidney transplant (KT) candidates with HIV face higher mortality on the waitlist compared with candidates without HIV. Because the HIV Organ Policy Equity (HOPE) Act has expanded the donor pool to allow donors with HIV (D + ), it is crucial to understand whether this has impacted transplant rates for this population.

Methods: Using a linkage between the HOPE in Action trial (NCT03500315) and Scientific Registry of Transplant Recipients, we identified 324 candidates listed for D + kidneys (HOPE) compared with 46 025 candidates not listed for D + kidneys (non-HOPE) at the same centers between April 26, 2018, and May 24, 2022. We characterized KT rate, KT type (D + , false-positive [FP; donor with false-positive HIV testing], D - [donor without HIV], living donor [LD]) and quantified the association between HOPE enrollment and KT rate using multivariable Cox regression with center-level clustering; HOPE was a time-varying exposure.

Results: HOPE candidates were more likely male individuals (79% versus 62%), Black (73% versus 35%), and publicly insured (71% versus 52%; P < 0.001). Within 4.5 y, 70% of HOPE candidates received a KT (41% D + , 34% D - , 20% FP, 4% LD) versus 43% of non-HOPE candidates (74% D - , 26% LD). Conversely, 22% of HOPE candidates versus 39% of non-HOPE candidates died or were removed from the waitlist. Median KT wait time was 10.3 mo for HOPE versus 60.8 mo for non-HOPE candidates ( P < 0.001). After adjustment, HOPE candidates had a 3.30-fold higher KT rate (adjusted hazard ratio = 3.30, 95% confidence interval, 2.14-5.10; P < 0.001).

Conclusions: Listing for D + kidneys within HOPE trials was associated with a higher KT rate and shorter wait time, supporting the expansion of this practice for candidates with HIV.

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Conflict of interest statement

D.L.S. receives honoraria for AstraZeneca, CareDx, Houston Methodist, Northwell Health, Optum Health Education, Sanofi, and WebMd, as well as consulting fees from AstraZeneca, CareDx, Moderna Therapeutics, Novavax, Regeneron, and Springer Publishing. C.M.D. received honoraria from Gilead Sciences for serving on a grant review committee. V.S. received research grant support from Eli Lilly and Company and consulting fees from DiaSorin SpA. M.P. received grant support from Merck, Hologic, Moderna, Shire/Takeda, and Pfizer, as well as provided consultation to/serves on the advisory board for Rebiotix, Takeda, and Union Therapeutics. C.B.S. has received grants paid to her institution from GlaxoSmithKline, ViiV, Abbott, Merck, Gilead, Chimerix, Shire/Takeda, Schering-Plough, Ablynx, Janssen, Ansun Biopharma, and Karyopharm Therapeutics. G.H. is a recipient of research grants from Allovir, Karius, and AstraZeneca. G.H. serves on the scientific advisory boards of Karius and AstraZeneca and has received honoraria from MDOutlook and MAD-ID/ID Connect. J.H. is a recipient of grants paid to his institution from Pfizer, Janssen, and Scynexis. The other authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Waitlist outcomes of HOPE and non-HOPE candidates. Fifty-four-month (4.5 y) cumulative incidence of death, waitlist removal, remaining waitlisted, receipt of living donor kidney transplant and deceased donor kidney transplant for HOPE (A) and non-HOPE candidates (B). Estimates were obtained using a competing risk framework (see Materials and Methods), with solid black lines representing candidates who were eventually transplanted. Estimates may go >100% due to rounding. Reasons for removal include refused transplant, transferred to another center*, candidate condition improved, transplant at another center, candidate removed in error, candidate changed to kidney pancreas*, transplanted at another center*, unable to contact candidate, and other reasons for removal among HOPE candidates. D+, donor with HIV; D−, donor without HIV; FP, donor with false-positive HIV test; HOPE, HIV Organ Policy Equity; KT, kidney transplant.
FIGURE 2.
FIGURE 2.
Cumulative incidence of time to kidney transplant for HOPE and non-HOPE candidates. Fifty-four-month (4.5 y) cumulative incidence of time to kidney transplant for HOPE and non-HOPE candidates. HOPE, HIV Organ Policy Equity.
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