Barriers to listing for HIV‐infected patients being evaluated for kidney transplantation

Abstract

Background Human immunodeficiency virus (HIV)-infected patients have excellent outcomes following kidney transplantation (KT) but still might face barriers in the evaluation and listing process. The aim of this study was to characterize the patient population, referral patterns, and outcomes of HIV-infected patients who present for KT evaluation. Methods We performed a single-center retrospective cohort study of HIV-infected patients who were evaluated for KT. The primary outcome was time to determination of eligibility for KT. Results Between 2011 and 2015, 105 HIV-infected patients were evaluated for KT. Of the 105 patients, 73 were listed for transplantation by the end of the study period. For those who were deemed ineligible, the most common reasons cited were active substance abuse (n = 7, 22%) and failure to complete the full transplant evaluation (n = 7, 22%). Conclusion Our cohort demonstrated a higher proportion of HIV-infected patients eligible for KT than in previous studies, likely secondary to advances in HIV management., Among those who were denied access to transplantation, we identified that many were unable to complete the evaluation process, and that active substance was common. Future prospective studies should examine reasons and potential interventions for the lack of follow-through and drug use we observed in this population.

Disparity in access to kidney allograft offers among transplant candidates with human immunodeficiency virus

“…HIV+ candidates face numerous barriers to transplantation. They are subject to a more intensive evaluation process that often prolongs their time to waitlisting . Not all transplant centers will accept them as candidates, although the number of transplants performed in HIV+ recipients at centers that did not participate in the original NIH multicenter trial has grown .…”

“…One study demonstrated that only 30% of HIV+ candidates referred for transplantation at a single center were ultimately listed, compared to 73% of their HIV negative (HIV‐) contemporaries . A more recent analysis reported improved rates of listing (70%) but 22.6% of candidates were unable to complete all of the testing required for listing and 50% of those ultimately listed for transplant experienced delays in navigating the evaluation process . Unfortunately, waitlisting alone does not guarantee transplant access for HIV+ patients.…”

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

“…One of the main differences was HCV coinfection, which was more frequent among PLHIV. Previous studies showed that active drug use, psychosocial difficulties, and medical insurance issues act as barriers to waiting list enrollment of PLHIV, 31,32 and HCV coinfection could be considered as a proxy for these characteristics. However, when the analyses were performed on the subgroup of patients without HCV, both the access to the WL and to KT remained severely compromised for PLHIV compared to HIV-uninfected individuals.…”

“…Previous studies showed that active drug use, psychosocial difficulties, and medical insurance issues act as barriers to waiting list enrollment of PLHIV,31,32 and HCV coinfection could be considered as a proxy for these characteristics. PLHIV and controls showed relatively similar comorbidities.…”

Kidney Transplantation in a HIV-Positive Recipient

“…Timely referral for kidney transplantation is crucial for HIV-positive transplant candidates because their transplant evaluation process is lengthier and more complex. In addition to the standard evaluation performed by the nephrologist and surgeon, which includes cardiac risk stratification and general health maintenance screenings, HIV-positive candidates require a careful assessment of their social support and substance abuse history; active substance abuse issues are a common reason HIV-positive candidates fail to achieve waitlisting (2). Additionally, as many are coinfected with hepatitis C (HCV) or hepatitis B, evaluation by a hepatologist is often necessary.…”