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

• Type of Material: Article
• Authors: Christine M Durand, Johns Hopkins University; Wanying Zhang, Johns Hopkins University; Diane M Brown, Johns Hopkins University; Sile Yu, Johns Hopkins University; Niraj Desai, Johns Hopkins University; Andrew D Redd, Johns Hopkins University; Serena M Bagnasco, Johns Hopkins University; Fizza F Naqvi, Johns Hopkins University; Shanti Seaman, Johns Hopkins University; Brianna L Doby, Johns Hopkins University; Darin Ostrander, Johns Hopkins University; Mary Grace Bowring, Johns Hopkins University; Yolanda Eby, Johns Hopkins University; Reinaldo E Fernandez, Johns Hopkins University; Rachel Friedman-Moraco, Emory University; Nicole Turgeon, Emory University; Peter Stock, University of California San Francisco; Peter Chin-Hong, University of California San Francisco; Shikha Mehta, University of Alabama Birmingham; Valentina Stosor, Northwestern University; Catherine B Small, Weill Cornell Medicine; Gaurav Gupta, Virginia Commonwealth University; Sapna A Mehta, New York University; Cameron R Wolfe, Duke University; Jennifer Husson, University of Maryland, Baltimore; Alexander Gilbert, Georgetown University; Matthew Cooper, Georgetown University; Oluwafisayo Adebiyi, Indiana University Health Hospital; Avinash Agarwal, University of Virginia; Elmi Muller, University of Cape Town; Thomas C Quinn, Johns Hopkins University; Jonah Odim, National Institute of Allergy and Infectious Diseases, NIH, Bethesda; Shirish Huprikar, The Mount Sinai Hospital, New York; Sander Florman, The Mount Sinai Hospital, New York; Allan B Massie, Johns Hopkins University; Aaron AR Tobian, Johns Hopkins University; Dorry L Segev, Johns Hopkins University
• Language: English
• Date: 2020-08-08
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.16205
• Title of Journal or Parent Work: AMERICAN JOURNAL OF TRANSPLANTATION
• Volume: 21
• Issue: 5
• Start Page: 1754
• End Page: 1764
• Grant/Funding Information: This work was supported by the by NIH’s National Institute of Allergy and Infectious Diseases grant numbers 1P30AI094189 (Johns Hopkins Center for AIDS Research), 1R01AI120938 (Tobian), U01AI138897 (Durand/Segev), and U01AI134591 (Durand/Segev) and in part by the Division of Intramural Research, NIAID, NIH (Quinn and Redd) and the Regional Oncology Research Center, 3P30CA006973 NCI/NIH (Nelson). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
• Keywords: Transplantation; OUTCOMES; ethics and public policy; infectious disease; clinical trial; infection and infectious agents - viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS); donors and donation; STAGE RENAL-DISEASE; ALLOGRAFT-REJECTION; infection and infectious agents; clinical research/practice; DRUG-RESISTANCE; IMMUNOSUPPRESSION; Life Sciences & Biomedicine; deceased; RISK; rejection; Science & Technology; kidney transplantation/nephrology; Surgery; FREQUENCY; SURVIVAL; law/legislation; INFECTION; PREVALENCE

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.