Early steps to kidney transplantation among persons with HIV and end‐stage renal disease in ESRD network 6. Issue 1 (14th December 2021)

• Record Type: Journal Article
• Authors: Adekunle, Ruth O.; Zhang, Rebecca; Wang, Zhengsheng; Patzer, Rachel E.; Mehta, Aneesh K.
• Is Part Of: Transplant infectious disease. Volume 24:Issue 1(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-12-14
• Subjects: access to transplant -- disparities -- kidney transplant -- persons with HIV; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13767
• Languages: English
• ISSNs: 1398-2273

Abstract

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.