Unmet Need for Solid Organ Transplantation among People with HIV and End Stage Kidney or Liver Disease: a Brief Report from the HIV Outpatient Study, 2009-2023.

Abstract

Persons with HIV (PWH) with end stage kidney disease (ESKD) who are eligible for kidney transplantation have post-transplantation outcomes similar to those without HIV infection. However, barriers to referral to care, evaluation, and receipt of transplants remain for PWH. We sought to identify PWH with ESKD or end stage liver disease (ESLD) who would be candidates for organ transplant and to review their clinical outcomes. We analyzed data from participants in the HIV Outpatient Study (HOPS) between 01-01-2009 and 06-30-2023, with a diagnosis of ESKD or ESLD. We identified a subset of PWH who would otherwise meet the general criteria for kidney or liver transplantation. Targeted clinical outcomes included dialysis, transplantation, and death. Among 5,215 PWH in the HOPS, 258 with ESKD and 23 with ESLD would otherwise meet criteria for transplant. However, only 9 kidney and 2 liver transplants were performed. Low transplantation rates among eligible PWH may suggest timely referral to care and evaluation for kidney and liver transplantation often does not occur. Expanding access for PWH with ESKD to both deceased and living donor kidney allografts is needed. Kidney and liver transplant centers also need to seek ways to broaden access to eligible PWH with ESKD or ESLD.