Access to kidney transplantation among HIV-infected waitlist candidates

Jayme E. Locke, Shikha Mehta, Deirdre Sawinski, Sally Gustafson, Brittany A. Shelton, Rhiannon D. Reed, Paul Maclennan, Charlotte Bolch, Christine Durand, Allan B Massie, Roslyn B. Mannon, Robert Gaston, Michael Saag, Turner Overton, Dorry Segev

Research output: Contribution to journalArticle

Abstract

Background and objectives Kidney transplantation among HIV-infected patients with ESRD confers a significant survival benefit over remaining on dialysis. Given the high mortality burden associated with dialysis, understanding access to kidney transplantation after waitlisting among HIV+ candidates is warranted. Design, setting, participants, & measurements Data from the Scientific Registry of Transplant Recipients were linked to Intercontinental Marketing Statistics pharmacy fills (January 1, 2001 to October 1, 2012) so that we could identify and study 1636 HIV+ (defined as having filled one or more antiretroviral medications unique to HIV treatment) and 72,297 HIV2 kidney transplantation candidates. Results HIV+ waiting list candidates were more often young (,50 years old: 62.7% versus 37.6%; P,0.001), were more often men (75.2% versus 59.3%; P,0.001), were more often black (73.6% versus 27.9%; P,0.001), had longer time on dialysis (years: 2.5 versus 0.8; P,0.001), were more often coinfected with hepatitis C virus (9.0% versus 3.9%; P,0.001), and were less likely to remain active on the waiting list (37.7% versus 49.4%; P,0.001). Waitlist mortality among HIV+ candidates was similar compared with HIV2 candidates (adjusted hazard ratio, 1.03; 95% confidence interval, 0.89 to 1.20; P=0.67). In contrast, likelihood of living donor kidney transplantation was 47% lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.44 to 0.64; P,0.001), and there was a trend toward lower likelihood of deceased donor kidney transplantation (adjusted hazard ratio, 0.87; 95% confidence interval, 0.74 to 1.01; P=0.07) compared with in HIV2 candidates. Conclusions Our findings highlight the need for additional study to better understand disparities in access to kidney transplantation, particularly living donor kidney transplantation, among HIV+ kidney waitlist candidates.

Original languageEnglish (US)
Pages (from-to)467-475
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number3
DOIs
StatePublished - 2017

Fingerprint

Kidney Transplantation
HIV
Dialysis
Waiting Lists
Living Donors
Confidence Intervals
Mortality
Marketing
Hepacivirus
Chronic Kidney Failure
Registries
Tissue Donors
Kidney
Survival

Keywords

  • African Continental Ancestry Group
  • Chronic
  • Coinfection
  • End-stage renal disease
  • Hepatitis C
  • HIV
  • HIV Infections
  • HIV-1
  • Humans
  • Kidney Failure
  • Kidney transplantation
  • Living Donors
  • Male
  • Renal dialysis

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Access to kidney transplantation among HIV-infected waitlist candidates. / Locke, Jayme E.; Mehta, Shikha; Sawinski, Deirdre; Gustafson, Sally; Shelton, Brittany A.; Reed, Rhiannon D.; Maclennan, Paul; Bolch, Charlotte; Durand, Christine; Massie, Allan B; Mannon, Roslyn B.; Gaston, Robert; Saag, Michael; Overton, Turner; Segev, Dorry.

In: Clinical Journal of the American Society of Nephrology, Vol. 12, No. 3, 2017, p. 467-475.

Research output: Contribution to journalArticle

Locke, JE, Mehta, S, Sawinski, D, Gustafson, S, Shelton, BA, Reed, RD, Maclennan, P, Bolch, C, Durand, C, Massie, AB, Mannon, RB, Gaston, R, Saag, M, Overton, T & Segev, D 2017, 'Access to kidney transplantation among HIV-infected waitlist candidates', Clinical Journal of the American Society of Nephrology, vol. 12, no. 3, pp. 467-475. https://doi.org/10.2215/CJN.07460716
Locke, Jayme E. ; Mehta, Shikha ; Sawinski, Deirdre ; Gustafson, Sally ; Shelton, Brittany A. ; Reed, Rhiannon D. ; Maclennan, Paul ; Bolch, Charlotte ; Durand, Christine ; Massie, Allan B ; Mannon, Roslyn B. ; Gaston, Robert ; Saag, Michael ; Overton, Turner ; Segev, Dorry. / Access to kidney transplantation among HIV-infected waitlist candidates. In: Clinical Journal of the American Society of Nephrology. 2017 ; Vol. 12, No. 3. pp. 467-475.
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abstract = "Background and objectives Kidney transplantation among HIV-infected patients with ESRD confers a significant survival benefit over remaining on dialysis. Given the high mortality burden associated with dialysis, understanding access to kidney transplantation after waitlisting among HIV+ candidates is warranted. Design, setting, participants, & measurements Data from the Scientific Registry of Transplant Recipients were linked to Intercontinental Marketing Statistics pharmacy fills (January 1, 2001 to October 1, 2012) so that we could identify and study 1636 HIV+ (defined as having filled one or more antiretroviral medications unique to HIV treatment) and 72,297 HIV2 kidney transplantation candidates. Results HIV+ waiting list candidates were more often young (,50 years old: 62.7{\%} versus 37.6{\%}; P,0.001), were more often men (75.2{\%} versus 59.3{\%}; P,0.001), were more often black (73.6{\%} versus 27.9{\%}; P,0.001), had longer time on dialysis (years: 2.5 versus 0.8; P,0.001), were more often coinfected with hepatitis C virus (9.0{\%} versus 3.9{\%}; P,0.001), and were less likely to remain active on the waiting list (37.7{\%} versus 49.4{\%}; P,0.001). Waitlist mortality among HIV+ candidates was similar compared with HIV2 candidates (adjusted hazard ratio, 1.03; 95{\%} confidence interval, 0.89 to 1.20; P=0.67). In contrast, likelihood of living donor kidney transplantation was 47{\%} lower (adjusted hazard ratio, 0.53; 95{\%} confidence interval, 0.44 to 0.64; P,0.001), and there was a trend toward lower likelihood of deceased donor kidney transplantation (adjusted hazard ratio, 0.87; 95{\%} confidence interval, 0.74 to 1.01; P=0.07) compared with in HIV2 candidates. Conclusions Our findings highlight the need for additional study to better understand disparities in access to kidney transplantation, particularly living donor kidney transplantation, among HIV+ kidney waitlist candidates.",
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T1 - Access to kidney transplantation among HIV-infected waitlist candidates

AU - Locke, Jayme E.

AU - Mehta, Shikha

AU - Sawinski, Deirdre

AU - Gustafson, Sally

AU - Shelton, Brittany A.

AU - Reed, Rhiannon D.

AU - Maclennan, Paul

AU - Bolch, Charlotte

AU - Durand, Christine

AU - Massie, Allan B

AU - Mannon, Roslyn B.

AU - Gaston, Robert

AU - Saag, Michael

AU - Overton, Turner

AU - Segev, Dorry

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N2 - Background and objectives Kidney transplantation among HIV-infected patients with ESRD confers a significant survival benefit over remaining on dialysis. Given the high mortality burden associated with dialysis, understanding access to kidney transplantation after waitlisting among HIV+ candidates is warranted. Design, setting, participants, & measurements Data from the Scientific Registry of Transplant Recipients were linked to Intercontinental Marketing Statistics pharmacy fills (January 1, 2001 to October 1, 2012) so that we could identify and study 1636 HIV+ (defined as having filled one or more antiretroviral medications unique to HIV treatment) and 72,297 HIV2 kidney transplantation candidates. Results HIV+ waiting list candidates were more often young (,50 years old: 62.7% versus 37.6%; P,0.001), were more often men (75.2% versus 59.3%; P,0.001), were more often black (73.6% versus 27.9%; P,0.001), had longer time on dialysis (years: 2.5 versus 0.8; P,0.001), were more often coinfected with hepatitis C virus (9.0% versus 3.9%; P,0.001), and were less likely to remain active on the waiting list (37.7% versus 49.4%; P,0.001). Waitlist mortality among HIV+ candidates was similar compared with HIV2 candidates (adjusted hazard ratio, 1.03; 95% confidence interval, 0.89 to 1.20; P=0.67). In contrast, likelihood of living donor kidney transplantation was 47% lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.44 to 0.64; P,0.001), and there was a trend toward lower likelihood of deceased donor kidney transplantation (adjusted hazard ratio, 0.87; 95% confidence interval, 0.74 to 1.01; P=0.07) compared with in HIV2 candidates. Conclusions Our findings highlight the need for additional study to better understand disparities in access to kidney transplantation, particularly living donor kidney transplantation, among HIV+ kidney waitlist candidates.

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KW - Hepatitis C

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KW - HIV Infections

KW - HIV-1

KW - Humans

KW - Kidney Failure

KW - Kidney transplantation

KW - Living Donors

KW - Male

KW - Renal dialysis

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