Kidney transplant outcomes similar with organs from deceased donors with, without HIV
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Key takeaways:
- Kidney recipients with HIV had similar outcomes with organs from deceased donors with or without HIV.
- Breakthrough HIV infection was three times higher among recipients of organs from donors with HIV.
For organ transplant recipients with HIV, kidneys from deceased donors with HIV are noninferior those from donors without HIV, according to data from a U.S. multicenter observational trial.
As Healio previously reported, federal regulations require patients with HIV in need of a kidney or liver transplant to participate in a clinical study to receive an organ from a donor with HIV. HHS is considering eliminating the trial participation requirement.
“Kidney transplantation from donors with HIV to recipients with HIV is a strategy that addresses the organ shortage and mitigates disparities in mortality among candidates on the waiting list and in transplantation access,” Christine M. Durand, MD, assistant professor of medicine and oncology in the department of medicine at Johns Hopkins University School of Medicine in Baltimore, and colleagues wrote.
Researchers compared data from the Scientific Registry of Transplant Recipients on 198 kidney recipients with HIV — 99 received organs from 82 donors without HIV, and 99 received organs from 64 donors with HIV. In both groups, median age was between 53 and 57 years, more than 80% were men and about 70% were identified as Black. The primary safety outcome was a composite of all-cause death, graft loss, serious adverse event, HIV breakthrough infection or persistent treatment failure, or opportunistic infection.
At a median follow-up of 2.2 and 2.3 years for HIV-positive and HIV-negative organs, respectively, the adjusted HR for the primary outcome was 1 (05% CI, 0.73-1.38), which met study criteria for noninferiority.
At years 1 and 3, overall rates of survival and survival without graft loss were similar between the groups, as were rates of organ rejection. Notably, opportunistic infections — most commonly cytomegalovirus and esophageal candidiasis — were observed for 11 recipients in the HIV-positive donor group and eight in the negative group. The incidence rate ratio of breakthrough HIV infection was three times higher among the group with HIV-positive donors (IRR = 3.14; 95% CI, 1.02-9.63); all cases resolved within 26 days, and 11 of the 17 cases were attributable to nonadherence to antiretroviral therapy, according to the researchers.
One recipient in the HIV-positive donor group had a genetically distinct HIV virus after transplantation, a potential superinfection event, according to the researchers.
“Donor-derived HIV superinfection is a risk associated with the transplantation of kidneys from donors with HIV to recipients with HIV, which could contribute to HIV breakthrough infection or to persistent failure of HIV treatment,” the researchers wrote. “[Together with results of other small studies] these data suggest that HIV superinfection is rare and is without clear clinical ramifications.”
The researchers recommend expanding the use of HIV-positive donor kidneys beyond only research to clinical care.
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