79. Clinical and Healthcare Utilization Outcomes of Kidney Transplantation in HIV-Positive Recipients: A Nationwide Analysis from 2008-2013
Session: Oral Abstract Session: Infections in Transplantation
Thursday, October 27, 2016: 8:45 AM
Room: 388-390

Background: Kidney transplantation (KTxp) provides dialysis independence, improves quality of life and prolongs life expectancy for patients with advanced kidney disease. In the early/pre-ART era, KTxp was not a consideration for HIV+ve pts with advanced kidney disease given their short life expectancy and prevailing organ procurement constraints. Recent advancements in ART /HIV care have overhauled this paradigm and KTxp has now been performed for several years. Unfortunately data on outcomes of KTxp in HIV+ve recipients is limited. We sought to evaluate clinical and healthcare utilization outcomes of KTxp in the US

Methods: Utilizing the Inpatient Databases of the Healthcare Cost & Utilization Project from 2008-2013, we identified all adult Ktxp recipients by procedural codes and HIV +ve recipients by ICD-9 codes. We extracted demographic, clinical & resource utilization variables comparing HIV+ve recipients to HIV-ve counterparts. We then performed descriptive statistics and multivariate analysis using logistic regression to assess the effect of HIV on clinical & utilization outcomes.

Results:  

Characteristics

HIV-ve Ktxp

HIV+ve Ktxp

Overall

P-value

Weighted

103532(99.42)

605(0.58)

104137

 

Patient level variables

 

 

 

 

Age

 

 

 

<0.001

18-34

14.27

8.77

14.24

 

35-49

29.44

49.21

29.55

 

50-64

39.53

37.1

39.52

 

>=65

16.75

4.92

16.69

 

Gender

 

 

 

<0.001

Male

60.57

75.82

60.65

 

Female

39.43

24.18

39.35

 

Primary Payer

 

 

 

<0.001

Medicare

59.12

81.5

59.25

 

Medicaid

3.81

5.53

3.82

 

Private including HMO

33.4

11.37

33.27

 

Self pay/no charge/other

0.46

0

0.46

 

Disposition

 

 

 

0.2995

Home

79.97

82.36

79.98

 

Home with Home care

16.75

15.06

16.74

 

Short term hospital

0.11

0

0.11

 

Facility

2.56

1.76

2.56

 

Hospital characteristics

 

 

 

 

Hospital Teaching status

 

 

 

0.0015

Non-teaching

2.98

0.81

2.97

 

Teaching

96.09

99.19

96.11

 

In hospital mortality

 

 

 

 

Overall

0.56

0.83

0.57

0.3916

Length of stay

7.69±0.07

8.66±0.8

7.70±0.067

0.2265

Length of stay amongst survivors

7.60±0.06

8.16±0.62

7.60±0.06

0.369

Total hospital charges

197059±1113

196771±13927

197057±1110

0.9836

Hospital charges amongst survivors

195099±1074

186568±9558

195048±1069

0.3768

Mechanical Ventilation <96 hours

2.01

3.32

2.01

0.0215

Mechanical Ventilation >=96 hours

0.82

0.83

0.82

0.994

Infectious Complications

8.81

8

8.81

0.4814

Rejection

20.75

27.5

20.79

<0.001

Conclusion: HIV+ve Ktxp recipients had higher allograft rejection, otherwise clinical & fiscal outcomes were similar to HIV-ve recipients

 

Senu Apewokin, MD, University of Cincinnati, Cincinnati, OH, Rajat Madan, MD/PhD, Univ of Cincinnati, Cincinnati, OH, Alejandro Restrepo, MD, Baylor College of Medicine, Houston, TX, Vagish S. Hemmige, MD, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX and Shilpkumar Arora, MD, MPH, Mount Sinai St Luke Roosevelt, New York, NY

Disclosures:

S. Apewokin, None

R. Madan, None

A. Restrepo, None

V. S. Hemmige, None

S. Arora, None

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