Access to the Kidney Transplant Waitlist for People With HIV.
Access to the Kidney Transplant Waitlist for People With HIV.
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DOI：
10.1097/tp.0000000000004549
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发表时间：
2023-05-01
期刊：
影响因子：
6.2
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中科院分区：
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血液和组织安全性和可用性咨询委员会最近投票决定取消美国国立卫生研究院的法定研究标准和机构审查委员会对使用艾滋病毒捐赠者的肾脏进行肾移植的要求。这一政策变化可能会增加对这些机构的利用。1尽管肾移植结果良好，但单中心研究表明，与未感染艾滋病毒的人相比，美国艾滋病毒感染者（PWH）的肾移植等待名单添加率显着降低，这是已故供体肾移植的必要步骤。2-4如果在实施这一政策后，使用艾滋病毒捐赠者的肾脏进行移植的情况有所增加，那么了解全国范围内的等待名单就势在必行。认识到艾滋病毒特异性数据缺乏粒度，我们使用美国肾脏数据系统和随附的医疗保险索赔数据来确定一组患有终末期肾病（ESKD）的PWH（2007年1月1日至2016年12月31日），并比较PWH与ESKD患者之间的等待名单添加率。这项研究得到了伯明翰亚拉巴马大学机构审查委员会的批准。在602006例主要支付者为医疗保险的事件患者中，使用慢性疾病数据仓库算法定义了5种HIV状态（敏感性：93.2%;特异性：99.4%）。在透析开始后90天内声称机会性感染的PWH被排除在外。考克斯比例风险和精细和灰色竞争风险回归被用来检查waitlist addition.The 6250 PWH的可能性更年轻，更常见的非洲裔美国人，更常见的报告酒精依赖，药物依赖和烟草使用。在开始透析后5年内增加等候名单的累积发生率在PWH中为11.1%，在无HIV的ESKD患者中为15.3%。在对人口统计学、共病情况和地理位置进行调整后，HIV与等待名单增加的可能性降低52%相关（调整后的风险比：0.48; 95%置信区间，0.43-0.52; P< 0.001;表1）。在添加候补名单之前考虑死亡和活体供肾移植的竞争风险后，观察到类似的不平等（调整后的子分布风险比：0.45; 95%置信区间，0.42-0.49; P< 0.001）。
The Advisory Committee on Blood and Tissue Safety and Availability recently voted to remove the statutory National Institutes of Health research criteria and institutional review board requirements for performing kidney transplantation using kidneys from donors with HIV. This policy change may subsequently increase utilization of such organs. 1 Despite excellent kidney transplant outcomes, single-center studies have demonstrated significantly lower kidney transplant waitlist addition rates for people with HIV (PWH) in the United States as compared with those without HIV, a requisite step for deceased donor kidney transplantation. 2-4 Should adoption of transplantation using kidneys from donors with HIV increase following the implementation of this policy, understanding waitlist addition nationally is imperative. Acknowledging the lack of granularity in HIV-specific data, we used the United States Renal Data System and accompanying Medicare claims data to identify a cohort of PWH (January 1, 2007–December 31, 2016) with end-stage kidney disease (ESKD) and compared waitlist addition rates among PWH with ESKD patients without HIV. This study was approved by the Institutional Review Board at the University of Alabama at Birmingham. Among 602 006 incident patients whose primary payer was Medicare, 5 HIV status was defined using the Chronic Conditions Data Warehouse algorithm (sensitivity: 93.2%; specificity: 99.4%). PWH with claims for an opportunistic infection within 90 d of dialysis initiation were excluded. Cox proportional hazards and Fine and Gray competing risks regressions were used to examine the likelihood of waitlist addition.The 6250 PWH were younger, more commonly African American, and more commonly reported alcohol dependence, drug dependence, and tobacco use. Cumulative incidence of waitlist addition within 5 y of dialysis initiation was 11.1% among PWH and 15.3% among ESKD patients without HIV. Following adjustment for demographics, comorbid conditions, and geography, HIV was associated with 52% lower likelihood of waitlist addition (adjusted hazard ratio: 0.48; 95% confidence interval, 0.43-0.52; P< 0.001; Table 1). After accounting for competing risks of death and living donor kidney transplantation before waitlist addition, a similar inequity was observed (adjusted subdistribution hazard ratio: 0.45; 95% confidence interval, 0.42-0.49; P< 0.001).