By: Melissa J. Webb – https://www.healio.com/nephrology/transplantation/news/online/%7B88461176-c1d5-4153-aaf3-879af5c2137d%7D/patients-with-hiv-less-likely-to-be-waitlisted-for-kidney-transplant
BOSTON: According to research presented at the American Transplant Congress, patients with HIV were less likely to be placed on the kidney transplant waiting list than patients without HIV. They also experienced longer wait times from evaluation to placement.
“Patients with HIV and end-stage renal disease experience higher mortality on dialysis than those without HIV,” wrote Ashton A. Shaffer of Johns Hopkins University and colleagues. “These HIV-positive dialysis patients may face barriers to kidney transplantation resulting from delayed referrals or other factors identified at the time of evaluation.”
To compare the likelihood of being placed on the waiting list, researchers conducted a prospective longitudinal multicenter cohort study of 98 HIV-positive patients and 3,105 HIV-non-HIV patients, who had been evaluated for kidney transplantation between 2008 and 2017.
The researchers compared patient characteristics and estimated the likelihood of inclusion on the list by HIV status.
Compared with patients without HIV, patients with HIV were more likely to be younger (median age 54 years vs. 56 years), African American (91% vs. 43%), had cognitive impairment (15% vs. 6%), and had spent more time on dialysis before kidney transplant evaluation (median age 2.4 years vs. 1.3 years).
Within 1 year of the evaluation, 2,010 HIV-negative patients were included for transplantation (average time from evaluation to listing, 133 days) and 52 HIV-positive patients (average time from evaluation to listing, 315 days).
HIV-positive individuals were less likely to be included on the list (adjusted HR = 0.7; 95% CI, 0.52-0.93).
“Patients with HIV+ are less likely to have kidney transplant waiting lists that cannot be explained by differences in patient characteristics other than time on dialysis before evaluation,” the researchers wrote. “Targeted dialysis interventions for early referral and transplant evaluation may improve access to kidney transplantation in HIV+ patients with ESRD.”