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A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action |
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| Authors: | 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 Stosor Catherine 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 the HOPE in Action Investigators |
| Institution: | 1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;3. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA;4. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;5. Department of Medicine, Emory University, Atlanta, Georgia, USA Department of Surgery, Emory University, Atlanta, Georgia, USA;6. Department of Surgery, Emory University, Atlanta, Georgia, USA Department of Surgery, Dell Medical School, University of Texas, Austin, Texas, USA;7. Department of Medicine, University of California, San Francisco, California, USA;8. Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA;9. Department of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA;10. Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA;11. Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA;12. NYU Langone Transplant Institute, New York University Grossman School of Medicine, New York, New York, USA;13. Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA;14. Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA;15. Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, District of Columbia, USA;16. Department of Medicine, Indiana University Health Hospital, Indianapolis, Indiana, USA;17. Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA;18. Department of Surgery, University of Cape Town, Cape Town, South Africa;19. Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA;20. Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA;21. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Shared senior authorship. |
| 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. |
| 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 |