Access to Kidney Transplantation among HIV-Infected Waitlist Candidates

Abstract

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.

Access to the waiting list and to kidney transplantation for people living with HIV: A national registry study

“…26 Using the French national renal replacement therapy registry, and in a context of universal and free access to ART, we compared the access to the KT waiting list of PLHIV and matched HIV-uninfected patients who initiated dialysis between 2006 and 2010 and who were followed until December 2015. 26 Using the French national renal replacement therapy registry, and in a context of universal and free access to ART, we compared the access to the KT waiting list of PLHIV and matched HIV-uninfected patients who initiated dialysis between 2006 and 2010 and who were followed until December 2015.…”

Impact of antiretroviral regimen on renal transplant outcomes in HIV‐infected recipients

“…While IMS data provides an opportunity to follow trends, it is not all encompassing, especially in certain special populations. In a 2017 study from the same authors, only 56% of wait‐listed patients had recorded pharmacy fills in the IMS database after the time they were listed . Additionally, it is unclear which pharmacies and health systems provide access to this database, as a prior report to the President of the United States noted that pharmacies within facilities were not accounted for in IMS data .…”

“…In a 2017 study from the same authors, only 56% of wait-listed patients had recorded pharmacy fills in the IMS database after the time they were listed. 21 Additionally, it is unclear which pharmacies and health systems provide access to this database, as a prior report to the President of the United States noted that pharmacies within facilities were not accounted for in IMS data. 22 This includes mail order and hospital-based specialty pharmacies, which for many large transplant centers, including our own, most patients use to fill all of their medications initially post-transplant.…”

Infection in Renal Transplant Recipients

“…Widespread adoption of potent antiretroviral therapy (ARV) has contributed to a decline in ESRD among whites with HIV infection, but rates of ESRD are still disproportionately higher among affected blacks. 143 However, kidney transplantation is associated with a survival benefit, compared with remaining on the waitlist (adjusted risk ratio [aRR], 0.21; 95% CI, 0.10 to 0.42; P <0.001), for HIV-positive patients, as has been observed for other high-risk patient groups. Of the 309 HIV-positive patients evaluated at a single transplant center from 2000 to 2007, only 20% achieved wait-listing compared with 73% of HIV-negative patients during the same time period.…”