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Disparity in access to kidney allograft offers among transplant candidates with human immunodeficiency virus
- Source :
- Clinical transplantation. 33(2)
- Publication Year :
- 2018
-
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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Tissue and Organ Procurement
Waiting Lists
medicine.medical_treatment
HIV Infections
030230 surgery
Health Services Accessibility
Article
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Transplantation, Homologous
Healthcare Disparities
Kidney transplantation
Dialysis
Aged
Retrospective Studies
Aged, 80 and over
Transplantation
Proportional hazards model
business.industry
Hazard ratio
virus diseases
HIV
Retrospective cohort study
Hepatitis C
Middle Aged
medicine.disease
Tissue Donors
Transplant Recipients
030211 gastroenterology & hepatology
Female
Serostatus
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 13990012
- Volume :
- 33
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Clinical transplantation
- Accession number :
- edsair.doi.dedup.....fab19b4859980bf54c830e0e50077f6e