Kidney Transplants Between HIV-Positive Individuals Yield Excellent Outcomes

By Will Boggs MD

July 29, 2020

NEW YORK (Reuters Health) - Kidney transplants from HIV-positive deceased donors to HIV-positive recipients yield excellent transplant and HIV outcomes, according to results from a multicenter pilot study.

"The key clinical finding is that kidney transplantation from donors with HIV to transplant recipients with HIV is safe and effective," Dr. Christine Durand of Johns Hopkins University School of Medicine, in Baltimore, Maryland, told Reuters Health by email. "From a public-health perspective, providing more donor organs for people with HIV will help everyone on the transplant waiting list."

The HIV Organ Policy Equity (HOPE) Act made transplantations between HIV-positive donors and HIV-positive recipients possible in the U.S. beginning in 2015. Few studies have evaluated outcomes associated with these transplantations.

Dr. Durand and colleagues from 14 centers explored the safety of HIV donor-positive (D+)/recipient-positive (R+) transplants and directly compared HIV D+/R+ with HIV donor-negative (D-)/R+ kidney transplantation in a prospective observational study of 75 HIV-positive patients, of whom 25 received HIV D+/R+ transplants and 50 received HIV D-/R+ transplants.

Patient survival was 100% in both groups after a median follow-up of 1.4 years (D+) and 1.8 years (D-), the team reports in the American Journal of Transplantation.

Significantly fewer D+ recipients (12%) than D- recipients (42%) experienced delayed graft function, and there were more graft failures in D- recipients than in D+ recipients (five vs. two).

One-year graft survival rates were similar in D+ (91%) and D- recipients (92%), and one-year graft function was equivalent between the groups.

After accounting for follow-up time, there was a nonsignificant trend towards higher one-year rejection in D+ recipients (50% vs. 29%), however.

There was no difference in serious adverse event rates, infections requiring hospitalization, or HIV breakthroughs (which were rare).

There were no posttransplant malignancies in the D+ group, but in the D- group, there were three posttransplant malignancies (one each of Kaposi sarcoma, oropharyngeal carcinoma and gastric adenocarcinoma).

"I hope these findings encourage physicians to refer their patients with HIV and advanced kidney disease to transplant centers with active HOPE Act protocols, so their patients have optimal access to life-saving transplants from donors with and without HIV," Dr. Durand said. "I would also like to get the word out that everyone can make the decision to be a donor and save lives, including people living with HIV."

SOURCE: American Journal of Transplantation, online July 23, 2020.