Clinical and Health Care Utilization Outcomes of Kidney Transplantation in HIV-Positive Recipients: A Nationwide Analysis From 2008-2013
Clinical and Health Care Utilization Outcomes of Kidney Transplantation in HIV-Positive Recipients: A Nationwide Analysis From 2008-2013
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DOI：
10.1016/j.transproceed.2018.08.002
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发表时间：
2018-12-01
影响因子：
0.9
通讯作者：
Arora, S.
中科院分区：
文献类型：
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作者：
Apewokin, S.;Madan, R.;Arora, S.
背景。肾移植（KTxp）为终末期肾病患者提供透析独立性、改善生活质量和延长预期寿命。在早期抗逆转录病毒治疗时代之前和期间，鉴于艾滋病毒阳性（HIV+ve）的终末期肾病患者的预期寿命较短和普遍存在的器官获取限制，KTxp不是考虑因素。抗逆转录病毒治疗和艾滋病毒护理的最新进展彻底改变了这一模式，KTxp现已进行了数年，然而，缺乏记录结果的实用研究。我们在此通过报告美国的临床和医疗保健使用结果来证明KTxp对HIV+ve患者的有效性。利用2008-2013年医疗成本与利用项目的住院患者数据库，我们通过程序代码确定了所有KTxp的成年接受者，并通过ICD-9代码确定了HIV+ve的接受者。我们提取了人口统计学、临床和资源利用变量，并比较了HIV阳性受体和HIV阴性受体（HIV-ve）。然后，我们使用逻辑回归进行描述性统计和多变量分析，以评估HIV对临床和使用结果的影响。在研究期间，共有104,137名患者进行了肾脏移植。其中605名患者为HIV+ve。HIV+ve和HIV-ve患者的感染率相似（优势比[OR] 1.18，可信区间[CI] 0.58-2.40; P = .652）。住院死亡率也相似（OR 0.83, CI 0.18-3.69; P = 0.80）。HIV+ve患者的医院收费与HIV-ve患者没有差异（195,099 +/- 1074美元vs 186,567 +/- 9558美元；P = .38）。在移植住院期间，HIV+ve和HIV-ve患者的临床和财务结果具有可比性。
Background. Kidney transplantation (KTxp) provides dialysis independence, improved quality of life, and prolonged life expectancy for patients with end-stage renal disease. Before and during the early antiretroviral therapy era, KTxp was not a consideration for patients with end-stage renal disease who were HIV-positive (HIV+ve) given their short life expectancy and prevailing organ procurement constraints. Recent advancements in antiretroviral therapy and HIV care have overhauled this paradigm and KTxp has now been performed for several years, however, pragmatic studies documenting outcomes are lacking. We herein document the effectiveness of KTxp in patients who are HIV+ve by reporting clinical and health care utilization outcomes in the United States.Methods. Utilizing the Inpatient Databases of the Healthcare Cost & Utilization Project spanning 2008-2013, we identified all adult recipients of KTxp by procedural codes and recipients who are HIV+ve by ICD-9 codes. We extracted demographic, clinical, and resource utilization variables and compared recipients who are HIV+ve with those who are HIV-negative (HIV-ve). We then performed descriptive statistics and multivariate analysis using logistic regression to assess the effect of HIV on clinical and utilization outcomes.Results. A total of 104,137 patients had kidney transplants during the study period. Of the total, 605 patients were HIV+ve. Infections rates were similar among patients who were HIV+ve and HIV-ve (odds ratio [OR] 1.18, confidence interval [CI] 0.58-2.40; P = .652). In-hospital mortality rates were also similar (OR 0.83, CI 0.18-3.69; P =.80). Hospital charges for patients who were HIV+ve were no different from patients who were HIV-ve ($195,099 +/- 1074 vs $186,567 +/- 9558; P = .38).Conclusion. Clinical and fiscal outcomes are comparable among patients who are HIV+ve and HIV-ve during transplant hospitalization.