Disparity in access to kidney allograft offers among transplant candidates with human immunodeficiency virus.

Abstract:

BACKGROUND:Despite a survival benefit from transplantation and acceptable outcomes, patients with human immunodeficiency virus (HIV+) face barriers to kidney transplantation. Little is known about the acceptance or decline of organ offers on their behalf because waitlist registry data do not include HIV serostatus. METHODS:We performed a retrospective cohort study using match run data from the Organ Procurement and Transplantation Network, including every kidney offer from May 1, 2007, to July 3, 2013. HIV and hepatitis C virus (HCV) serostatus were obtained by merging the match run with clinical data from a large dialysis provider. We used Cox proportional hazards modeling to evaluate differences in time to the first organ offer and to transplantation. A total of 35 646 uninfected, 2213 HCV+, 418 HIV+, and 71 HIV+/HCV+ candidates received organ offers during the study period. RESULTS:Compared to uninfected candidates, HIV+ candidates had a significantly lower likelihood of receiving a first offer (adjusted hazard ratio [aHR] 0.88, 95% confidence interval [CI] 0.79-0.99) and undergoing transplantation (aHR 0.82, 95% CI: 0.68-0.98) after receiving a first offer; HCV+ candidates had a similar likelihood of receiving a first offer (aHR 0.98, 95% CI: 0.92-1.03) and greater likelihood of transplantation after receiving a first offer (aHR 1.23, 95% CI: 1.12-1.36). CONCLUSIONS:HIV+ candidates had a significantly longer wait until their first organ offer and to transplantation. Efforts to increase their access to transplantation are needed.

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

Cohen JB,Locke JE,Shelton B,Reed RD,Mustian M,MacLennan P,Forde KA,Reese PP,Sawinski D

doi

10.1111/ctr.13466

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

e13466

issue

2

eissn

0902-0063

issn

1399-0012

journal_volume

33

pub_type

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