TY - JOUR
T1 - A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation
T2 - HOPE in action
AU - the HOPE in Action Investigators
AU - Durand, Christine M.
AU - Zhang, Wanying
AU - Brown, Diane M.
AU - Yu, Sile
AU - Desai, Niraj
AU - Redd, Andrew D.
AU - Bagnasco, Serena M.
AU - Naqvi, Fizza F.
AU - Seaman, Shanti
AU - Doby, Brianna L.
AU - Ostrander, Darin
AU - Bowring, Mary Grace
AU - Eby, Yolanda
AU - Fernandez, Reinaldo E.
AU - Friedman-Moraco, Rachel
AU - Turgeon, Nicole
AU - Stock, Peter
AU - Chin-Hong, Peter
AU - Mehta, Shikha
AU - Stosor, Valentina
AU - Small, Catherine B.
AU - Gupta, Gaurav
AU - Mehta, Sapna A.
AU - Wolfe, Cameron R.
AU - Husson, Jennifer
AU - Gilbert, Alexander
AU - Cooper, Matthew
AU - Adebiyi, Oluwafisayo
AU - Agarwal, Avinash
AU - Muller, Elmi
AU - Quinn, Thomas C.
AU - Odim, Jonah
AU - Huprikar, Shirish
AU - Florman, Sander
AU - Massie, Allan B.
AU - Tobian, Aaron A.R.
AU - Segev, Dorry L.
N1 - Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - clinical research/practice
KW - clinical trial
KW - donors and donation: deceased
KW - ethics and public policy
KW - infection and infectious agents
KW - infection and infectious agents – viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
KW - infectious disease
KW - kidney transplantation/nephrology
KW - law/legislation
KW - rejection
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U2 - 10.1111/ajt.16205
DO - 10.1111/ajt.16205
M3 - Article
C2 - 32701209
AN - SCOPUS:85089075412
SN - 1600-6135
VL - 21
SP - 1754
EP - 1764
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 5
ER -