Chronic diseases, such as end-stage renal disease (ESRD), are now the leading causes of death among HIV+ patients. Multiple studies have demonstrated the efficacy of kidney transplant (KT) over dialysis in reducing mortality. While KT is now a viable option for select HIV+ patients, no study has examined its survival benefit vs. dialysis among HIV+ ESRD patients. IMS pharmacy fills (1/1/01-10/1/12) were linked with SRTR data. KT candidates who filled >1 antiretroviral (ARV) medication unique to HIV treatment were identified. Candidates were followed from the later of date of waitlisting or first known HIV medication fill; simultaneous listings were collapsed. Time-to-event (waitlisting to death or administrative end of study) survival analyses were performed using Cox proportional hazard modeling, and adjusted for covariates chosen by the LASSO procedure. Number of transplants was treated as a time-dependent categorical variable (0, 1, or 2). We identified 938 HIV+ KT candidates, 94% of whom had >1 ARV fill. First-time KT was associated with a 70% lower risk of death compared with continued dialysis [adjusted hazard ratio (AHR): 0.30, 95%CI: 0.22-0.40, p<0.0001]. In contrast, retransplant conferred no survival benefit among HIV+ ESRD patients [AHR: 1.8, 95%CI: 0.66-4.7, p=0.26]. Evidence suggests that HIV+ first-time KT recipients achieve a significant survival benefit from KT vs. continued dialysis.

« Back to 2015 American Transplant Congress