Date: Monday, June 3, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: Room 206
*Purpose: Heart disease is a leading cause of death for HIV+ individuals, and the number of HIV+ heart transplant (HT) recipients is growing. Although understanding waitlist outcomes is critical for candidate selection, UNOS did not historically record candidate HIV-status.
*Methods: To address this knowledge gap, we linked data from SRTR (1/1/07-12/31/16) to pharmacy fills (capturing 91.5% of the HT waitlist in study period) to identify HIV+ candidates (defined as ≥1 fill of HIV-specific medication). We summarized listing trends over time, compared candidate characteristics by HIV-status with chi-squared and ranksum tests and used Kaplan-Meier plots and Cox regression to model the risk of waitlist mortality (treating transplant as a censored and competing event, separately) and rate of transplant by HIV-status.
*Results: The number of transplant centers with experience listing HIV+ HT candidates increased over time, as did the number of HIV+ candidates listed each year (Figure 1).
Compared to HIV- candidates (n=35,724), HIV+ candidates (n=48; 0.2%) were more often male, African American, with higher education and heart failure caused by coronary heart disease (Table 1).
|Median Age (IQR)||52.0 (40.0-58.0)||53.0 (38.0-61.0)||0.3|
|% African American||45.8||22.1||<0.01|
|% Coronary Artery Disease||12.5||2.6||<0.001|
|% Prior Cardiac Surgery||41.3||40.5||0.9|
|% History of Cigarette Use||45.8||42.1||0.6|
|% Educational Attainment Beyond Highschool||72.8||44.4||<0.01|
Both waitlist mortality and access to HT were similar for HIV+ and HIV- candidates (cumulative 3-year: mortality 15.2 vs. 18.5%; transplant 63.7 vs. 60.0%, respectively; sdHR: 0.73 95%CI:0.36-1.5, p=0.4) (Figure 2).
*Conclusions: As more centers gain experience with HIV+ HT candidates, these waitlist results are reassuring. However, with the growing population of HIV+ HT candidates, it is imperative to monitor these outcomes over time.
To cite this abstract in AMA style:Shaffer AA, Thomas AG, Segev DL. The National Landscape of Heart Transplant Candidates with HIV [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-national-landscape-of-heart-transplant-candidates-with-hiv/. Accessed October 25, 2020.
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