Background: Despite having a demonstrated survival benefit with kidney transplantation, patients with chronic viral infections, such as HCV or HIV, face many barriers to transplantation, including a more complex evaluation process. There can also be a perception among providers that these candidates are prohibitively "high risk", despite demonstrated equivalent posttransplant outcomes for HIV+ recipients. The acceptance or decline of organ offers on their behalf is unstudied due to lack of HCV and HIV serostatus information among waitlisted patients.

Methods: We performed a retrospective cohort study using match-run data from the Organ Procurement and Transplantation Network (OPTN), including every kidney offer from May 1, 2007 through July 3, 2013. HIV and HCV serostatuses were obtained by merging the OPTN match-run with clinical data from a large dialysis provider. We used Cox proportional hazards modeling adjusted for candidate age, race, diabetes status, dialysis vintage, and maximum panel reactive antibody, and clustered by listing center to evaluate differences in time to the first organ offer and to transplantation.

Results: There were a total of 35,646 uninfected, 2,213 HCV+, 418 HIV+, and 71 HIV/HCV co-infected candidates who received organ offers during the study period. Compared to uninfected reference candidates, HCV+ candidates had no clinically significant difference in time to the first organ offer (110 days vs 117 days, p=0.045), but had a higher likelihood of receiving an offer (aHR 1.19, 1.06-1.34) and transplantation (aHR 1.11, 95% CI 1.01-1.22); this was driven by their access to HCV+ organs. HIV+ candidates had a significantly longer time to their first offer (median time to first offer 139 days; aHR 0.82, 95% CI 0.70-0.98), with fewer organ offers overall (median 4, IQR 2-11; p<0.001), kidneys that were accepted for them further down the match run sequence (median position 7, IQR 3-16; p=0.006), and lower likelihood of transplantation (aHR 0.79, 95% CI 0.65-0.96).

Conclusions: Compared to HCV+ or uninfected patients, HIV+ waitlist candidates had a significantly longer wait until their first organ offer and were less likely to achieve transplantation. Efforts to increase HIV+ transplant candidate access to transplantation are needed.

CITATION INFORMATION: Cohen J., Locke J., Shelton B., Reed R., MacLennan P., Sawinski D. Disparity in Access to Kidney Allograft Offers among HIV+ Transplant Candidates Am J Transplant. 2017;17 (suppl 3).

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