A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action

Christine M. Durand, Wanying Zhang, Diane M. Brown, Sile Yu, Niraj Desai, Andrew D. Redd, Serena M. Bagnasco, Fizza F. Naqvi, Shanti Seaman, Brianna L. Doby, Darin Ostrander, Mary Grace Bowring, Yolanda Eby, Reinaldo E. Fernandez, Rachel Friedman-Moraco, Nicole Turgeon, Peter Stock, Peter Chin-Hong, Shikha Mehta, Valentina StosorCatherine B. Small, Gaurav Gupta, Sapna A. Mehta, Cameron R. Wolfe, Jennifer Husson, Alexander Gilbert, Matthew Cooper, Oluwafisayo Adebiyi, Avinash Agarwal, Elmi Muller, Thomas C. Quinn, Jonah Odim, Shirish Huprikar, Sander Florman, Allan B. Massie, Aaron A.R. Tobian, Dorry L. Segev

Research output: Contribution to journalArticlepeer-review

Abstract

HIV-positive donor to HIV-positive recipient (HIV D+/R+) transplantation is permitted in the United States under the HIV Organ Policy Equity Act. To explore safety and the risk attributable to an HIV+ donor, we performed a prospective multicenter pilot study comparing HIV D+/R+ vs HIV-negative donor to HIV+ recipient (HIV D−/R+) kidney transplantation (KT). From 3/2016 to 7/2019 at 14 centers, there were 75 HIV+ KTs: 25 D+ and 50 D− (22 recipients from D− with false positive HIV tests). Median follow-up was 1.7 years. There were no deaths nor differences in 1-year graft survival (91% D+ vs 92% D−, P =.9), 1-year mean estimated glomerular filtration rate (63 mL/min D+ vs 57 mL/min D−, P =.31), HIV breakthrough (4% D+ vs 6% D−, P >.99), infectious hospitalizations (28% vs 26%, P =.85), or opportunistic infections (16% vs 12%, P =.72). One-year rejection was higher for D+ recipients (50% vs 29%, HR: 1.83, 95% CI 0.84-3.95, P =.13) but did not reach statistical significance; rejection was lower with lymphocyte-depleting induction (21% vs 44%, HR: 0.33, 95% CI 0.21-0.87, P =.03). In this multicenter pilot study directly comparing HIV D+/R+ with HIV D−/R+ KT, overall transplant and HIV outcomes were excellent; a trend toward higher rejection with D+ raises concerns that merit further investigation.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - 2020

Keywords

  • clinical research/practice
  • clinical trial
  • donors and donation: deceased
  • ethics and public policy
  • infection and infectious agents
  • infection and infectious agents – viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
  • infectious disease
  • kidney transplantation/nephrology
  • law/legislation
  • rejection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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