Trends in Renal Transplantation in Patients With Human Immunodeficiency Virus Infection: An Analysis of the United States Renal Data System

Background. We examined the United States Renal Data System registry to analyze trends in renal transplantation in patients with human immunodeficiency virus (HIV) infection. Methods. A retrospective cohort study was performed using the United States Renal Data System, analyzing patients receiving renal transplants from January 1, 1995, to September 29, 2006. Factors independently associated with transplantation in HIV-infected patients with end-stage renal disease were identified. Results. There was a significant increase in renal transplant recipients who were HIV seropositive who received renal transplants from 2001 to 2006 (n = 208, 0.26%) versus 1995 to 2000 era (n = 43, 0.06%, P < 0.001). Before 2001, only 18 states performed renal transplants in HIV-infected patients, whereas most states transplanted HIV-infected patients in the second era. There were more African American recipients with HIV infection from 2001 to 2006 compared with the earlier cohort (n = 118 vs. 8, P < 0.001). Patients with HIV infection were more likely to have received induction therapy (n = 121 vs. 37, P < 0.001) and tacrolimus maintenance suppression (n = 105 vs. 13, P < 0.001) in the latter era. There were also more deceased donor transplants from 2001 to 2006 (n = 143 vs. 25, P < 0.001). In logistic regression analysis, when adjusted for multiple factors including recipient and donor age, race, gender, and donor type, patients with HIV infection were more likely to have been transplanted after 2001 (adjusted odds ratio, 2.21; 95% confidence interval = 1.49-3.28). In analysis adjusted for multiple factors including hepatitis C virus coinfection, HIV infection was not significantly associated with all-cause graft loss. Conclusions. There has been a dramatic increase in the number of transplants among HIV-infected patients. These findings suggest improved access to transplant wait listing and better management of immunosuppression, especially among African American patients.