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

Clin Transplant. 2019 Feb;33(2):e13466. doi: 10.1111/ctr.13466. Epub 2019 Jan 12.

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.

Keywords: hepatitis C virus; human immunodeficiency virus; kidney transplantation; organ allocation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • HIV / isolation & purification
  • HIV Infections / epidemiology
  • HIV Infections / virology*
  • Health Services Accessibility*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tissue Donors / psychology*
  • Tissue and Organ Procurement / statistics & numerical data*
  • Transplant Recipients / statistics & numerical data*
  • Transplantation, Homologous
  • Waiting Lists*