title: Access to Kidney Transplantation among HIV-Infected Waitlist Candidates.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 HIV- 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 HIV- 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 HIV- 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.
authors.affiliation: Departments of Surgery and.
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.affiliation: Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama.
authors.forename: Shikha
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Medicine, University of Pennsylvania Comprehensive Transplant Center, Philadelphia, Pennsylvania.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Sawinski
authors.affiliation: Department of Analytics, Scientific Registry of Transplant Recipients, Minneapolis, Minnesota; and Departments of.
authors.forename: Sally
authors.initials: S
authors.lastname: Gustafson
authors.affiliation: Departments of Surgery and.
authors.forename: Brittany A
authors.initials: BA
authors.lastname: Shelton
authors.affiliation: Departments of Surgery and.
authors.forename: Rhiannon D
authors.initials: RD
authors.lastname: Reed
authors.affiliation: Departments of Surgery and.
authors.forename: Paul
authors.initials: P
authors.lastname: MacLennan
authors.affiliation: Department of Analytics, Scientific Registry of Transplant Recipients, Minneapolis, Minnesota; and Departments of.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Bolch
authors.affiliation: Medicine and.
authors.forename: Christine
authors.initials: C
authors.lastname: Durand
authors.affiliation: Surgery, Johns Hopkins University Comprehensive Transplant Center, Baltimore, Maryland.
authors.forename: Allan
authors.initials: A
authors.lastname: Massie
authors.affiliation: Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama.
authors.forename: Roslyn B
authors.initials: RB
authors.lastname: Mannon
authors.affiliation: Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama.
authors.forename: Robert
authors.initials: R
authors.lastname: Gaston
authors.affiliation: Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama.
authors.forename: Michael
authors.initials: M
authors.lastname: Saag
authors.affiliation: Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama.
authors.forename: Turner
authors.initials: T
authors.lastname: Overton
authors.affiliation: Surgery, Johns Hopkins University Comprehensive Transplant Center, Baltimore, Maryland.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D060085:Coinfection / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D012042:Registries; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult
keywords: African Continental Ancestry Group; Coinfection; HIV; HIV Infections; HIV-1; Hepatitis C; Humans; Kidney Failure, Chronic; Living Donors; Male; end-stage renal disease; kidney transplantation; renal dialysis