Kidney Week

Abstract: SA-PO091

Access to the Kidney Transplant Waitlist for Patients with HIV and ESRD

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Shaffer, Ashton A., Johns Hopkins University, Baltimore, Maryland, United States

Ashton A. Shaffer,

• Ying, Hao, Johns Hopkins University, Baltimore, Maryland, United States

Hao Ying,

• Chu, Nadia M., Johns Hopkins University, Baltimore, Maryland, United States

Nadia M. Chu,

• Thomas, Alvin G., UNC Chapel HIll, Chapel Hill, North Carolina, United States

Alvin G. Thomas,

• Haugen, Christine E., Johns Hopkins University, Baltimore, Maryland, United States

Christine E. Haugen,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States

Mara McAdams-DeMarco,

Background

Patients with HIV and end-stage renal disease (ESRD) experience higher mortality on dialysis than those without HIV. These HIV+ dialysis patients may face barriers to kidney transplantation (KT) that result from delayed referrals or factors identified at the time of evaluation.

Methods

We used a prospective, longitudinal multi-center cohort to study 98 HIV+ and 3,105 HIV- patients with ESRD who were evaluated for KT between 2008 and 2017. We compared patient characteristics and estimated the likelihood of listing by HIV-status using adjusted Cox regression. The presence of comorbidities was defined as a Charlson comorbidity index (CCI) score ≥1; cognitive impairment was defined as a mini-mental state exam score ≤80.

Results

Patients with HIV were more often young (median 54 vs. 56 years old), African American (91 vs. 43%), men (72 vs. 59%), with cognitive impairment (15 vs. 6%), and longer time on dialysis prior to KT evaluation (median 2.4 vs. 1.3 years) than those without HIV. Within 1 year of KT evaluation, 52 HIV+ and 2,010 HIV- patients were listed for KT; median time from evaluation to listing was 133 days for HIV- patients and 315 days for HIV+ patients (Figure 1). Adjusting for age, gender, African American race, comorbidities, and cognitive impairment, patients with HIV were less likely to be listed (aHR: 0.70, 95%CI: 0.52-0.93; p<0.05). However, additionally adjusting for time on dialysis attenuated this difference (aHR: 0.90, 95%CI: 0.67-1.20; p=0.5).

Conclusion

HIV+ patients have a lower likelihood of KT listing that is not explained by differences in patients’ characteristics other than time on dialysis prior to evaluation. Decreasing time from dialysis initiation to referral for evaluation may improve access to KT for HIV+ patients with ESRD.

Funding

• NIDDK Support