HIV 感染者和 ESRD 网络 6 中终末期肾病患者的肾移植早期步骤。
Early steps to kidney transplantation among persons with HIV and end-stage renal disease in ESRD network 6.
机构信息
Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
出版信息
Transpl Infect Dis. 2022 Feb;24(1):e13767. doi: 10.1111/tid.13767. Epub 2021 Dec 14.
INTRODUCTION
End-stage renal disease is a significant cause of morbidity and mortality in persons with HIV (PWH). Limited data exist on access to kidney transplantation for this population.
METHODS
A dataset inclusive of incident dialysis patients between 2012 and 2016 with follow-up through December 2017 that identifies PWH and the general dialysis population of Network 6 (Georgia, North Carolina, South Carolina) was created through merging the United States Renal Data System with the southeastern early transplant access registry. Early steps to kidney transplantation and patient and dialysis facility-level characteristics that serve as barriers to transplantation were described.
RESULTS
Twenty-three thousand four hundred fourteen patients were identified; 469 were PWH. Compared to non-HIV individuals, PWH were younger (49 vs. 58 years, p < 0.001), predominantly Black (87% vs. 56% p < 0.001) and male (72% vs. 56% p < 0.001). PWH were less likely to be referred to kidney transplant within 1 year of starting dialysis (36% vs. 41% p < 0.001) and waitlisted within 1 year of evaluation-start (14% vs. 30%, p = 0.05). PWH (vs. non-PWH) waited longer for referral, evaluation-start, and waitlisting and in multivariable analysis; HIV positivity was associated with a lower probability of referral (hazard ratios [HR]: 0.70; 95% confidence intervals [CIs]: 0.62-0.80), evaluation (HR 0.66; 95% CI: 0.55-0.80), and waitlisting (HR 0.29; 95% CI: 0.20-0.41).
CONCLUSIONS
Targeted interventions are needed to improve access to kidney transplants, particularly in waitlisting, for PWH.
简介
终末期肾病是导致艾滋病毒感染者（PWH）发病和死亡的重要原因。关于该人群接受肾移植的机会，目前数据有限。
方法
通过合并美国肾脏数据系统和东南部早期移植准入登记处，创建了一个包含 2012 年至 2016 年期间发生的透析患者数据的数据集，这些患者在 2017 年 12 月前进行了随访，并确定了 PWH 和网络 6（格鲁吉亚、北卡罗来纳州、南卡罗来纳州）的一般透析人群。描述了早期接受肾移植的步骤以及作为移植障碍的患者和透析机构特征。
结果
共确定了 23411 名患者；其中 469 名是 PWH。与非 HIV 个体相比，PWH 年龄更小（49 岁 vs. 58 岁，p<0.001），主要为黑人（87% vs. 56%，p<0.001）和男性（72% vs. 56%，p<0.001）。PWH 在开始透析后 1 年内被转介到肾移植的可能性较小（36% vs. 41%，p<0.001），在评估开始后 1 年内列入等待名单的可能性也较小（14% vs. 30%，p=0.05）。在多变量分析中，PWH（与非 PWH 相比）等待转介、评估开始和列入等待名单的时间更长；HIV 阳性与转介（风险比[HR]：0.70；95%置信区间[CI]：0.62-0.80）、评估（HR 0.66；95% CI：0.55-0.80）和列入等待名单（HR 0.29；95% CI：0.20-0.41）的可能性较低有关。
结论
需要采取有针对性的干预措施，以提高 PWH 接受肾移植的机会，特别是在列入等待名单方面。
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