The passage of the HOPE Act in November 2013 mandated research into HIV+ to HIV+ organ transplantation. To date, the prevalence of HIV in the deceased donor kidney transplant (DDKT) waitlist population has not been characterized. Since HIV status is not captured at the time of listing, it is impossible to know the exact number of HIV+ waitlist candidates. We highlight the potential impact of HIV+ organ transplant by calculating the prevalence of HIV in kidney transplant candidates.

Methods: SRTR data on adult kidney transplant recipients 2009-2013 were used to create a propensity score for HIV+ status, based on characteristics known at the time of waitlist registration (race, sex, employment status, insurance status, and comorbid conditions: diabetes mellitus, hypertension, hepatitis C virus infection), using logistic regression. The selected model was assessed for discrimination based on AUC and goodness-of-fit. Using this score, we calculated a probability of HIV+ status for each adult patient on the DDKT waitlist as of 3/2014, and summed those probabilities to obtain an estimate of the HIV+ DDKT waitlist population.

Results: The AUC of the model was 0.83, indicating good predictive accuracy (Figure 1). We estimated HIV prevalence to be 1390 DDKT registrants (1.34% of the DDKT waitlist population). The number of estimated new HIV+ registrants, both "confirmed" (known HIV status) and "estimated" (HIV status presumed by propensity score), per year has increased over time (Figure 2).

Conclusion: There were an estimated 1390 HIV+ DDKT registrants as of 3/2013. HIV+ to HIV+ DDKT would provide improved access to transplant for these patients, ultimately shortening the waitlist time for both HIV+ and HIV- transplant candidates, and thus benefitting all waitlist registrants.

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