Patients with HIV less likely to be waitlisted for kidney transplant

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BOSTON — Patients with HIV were less likely to be placed on the kidney transplant waitlist than patients without HIV, according to research presented at the American Transplant Congress. They also experienced longer wait-times from evaluation to listing.

“Patients with HIV and end-stage renal disease experience higher mortality on dialysis than those without HIV,” Ashton A. Shaffer, of Johns Hopkins University, and colleagues wrote. “These HIV+ dialysis patients may face barriers to kidney transplantation that result from delayed referrals or factors identified at the time of evaluation.”

To compare the likelihood of being waitlisted, researchers conducted a prospective longitudinal multi-center cohort study of 98 patients with HIV and 3,105 patients without HIV, who had been evaluated for kidney transplant between 2008 and 2017.

Researchers compared patient characteristics and estimated the likelihood of listing by HIV-status.

Compared with patients without HIV, patients with HIV were more likely to be younger (median 54 years vs. 56 years), African American (91% vs. 43%), have cognitive impairment (15% vs. 6%), and have spent more time on dialysis before kidney transplant evaluation (median 2.4 years vs. 1.3 years).

Within 1 year of evaluation, 2,010 patients without HIV were listed for transplant (median time from evaluation to listing, 133 days) and 52 patients with HIV were listed (median time from evaluation to listing, 315 days).

Patients with HIV were less likely to be placed on the kidney transplant waitlist than patients without HIV.

Source: Adobe Stock

After researchers adjusted for age, sex, African American race, comorbidities and cognitive impairment, they determined that patients with HIV were less likely to be listed (adjusted HR = 0.7; 95% CI, 0.52-0.93).

“HIV+ patients have a lower likelihood of kidney transplant listing that is not explained by differences in patients’ characteristics other than time on dialysis prior to evaluation,” the researchers wrote. “Targeted dialysis interventions for early referral and transplant evaluation may improve access to kidney transplantation for HIV+ patients with ESRD.” – by Melissa J. Webb

Reference:

Shaffer AA, et al. Abstract 443. Presented at: American Transplant Congress; June 1-5, 2019; Boston.

Disclosures: Healio/Nephrology was unable to determine relevant financial disclosures prior to publication.