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A prospective multicenter pilot study of HIV‐positive deceased donor to HIV‐positive recipient kidney transplantation: HOPE in action
Author(s) -
Durand Christine M.,
Zhang Wanying,
Brown Diane M.,
Yu Sile,
Desai Niraj,
Redd Andrew D.,
Bagnasco Serena M.,
Naqvi Fizza F.,
Seaman Shanti,
Doby Brianna L.,
Ostrander Darin,
Bowring Mary Grace,
Eby Yolanda,
Fernandez Reinaldo E.,
FriedmanMoraco Rachel,
Turgeon Nicole,
Stock Peter,
ChinHong Peter,
Mehta Shikha,
Stosor Valentina,
Small Catherine B.,
Gupta Gaurav,
Mehta Sapna A.,
Wolfe Cameron R.,
Husson Jennifer,
Gilbert Alexander,
Cooper Matthew,
Adebiyi Oluwafisayo,
Agarwal Avinash,
Muller Elmi,
Quinn Thomas C.,
Odim Jonah,
Huprikar Shirish,
Florman Sander,
Massie Allan B.,
Tobian Aaron A. R.,
Segev Dorry L.
Publication year - 2021
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16205
Subject(s) - medicine , transplantation , prospective cohort study , human immunodeficiency virus (hiv) , kidney transplantation , renal function , gastroenterology , immunology
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.