Liver disease is a leading cause of death for HIV+ individuals, and the number of HIV+ liver transplant recipients is increasing. However, since UNOS does not collect HIV status for waitlist registrants, the impact of HIV on candidate survival and access to LT has not been well characterized.

Methods: We linked data from SRTR (2002-20121) to pharmacy fills (IMS Health; covering 65% of the LT waitlist in study period) to identify HIV+ candidates (defined as ≥1 fill of HIV-specific medication). We modeled risk of waitlist mortality (censored for transplant) and rate of transplant (censored for death) for HIV+ vs. HIV- LT candidates using Cox regression, adjusting for MELD score at listing, age, sex, race, ethnicity, and Hepatitis C (HCV) status.

Results: We identified 581 LT candidates who were HIV+ at time of listing; 52% of whom were co-infected with HCV. HIV+ status was associated with 43% higher risk of waitlist mortality (aHR=_1.261.43_1.63, p<0.001) and 41% lower rate of transplant (aHR=_0.500.59_0.70, p<0.001), adjusting for candidate factors.

Discussion: HIV+ LT candidates face a higher risk of waitlist death and lower risk of receiving a transplant, compared with their HIV- counterparts. Understanding this disparity in waitlist outcomes and access to LT is critical for improving care for HIV+ candidates.

CITATION INFORMATION: Shaffer A., Thomas A., Massie A., Gustafson S., Snyder J., Shelton B., Reed R., Locke J., Segev D., Durand C. Waitlist Outcomes and Access to Liver Transplantation for HIV+ Candidates Am J Transplant. 2017;17 (suppl 3).

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