Good Long-Term Outcomes of Kidney/Liver Transplant in Adults With HIV

By Reuters Staff

January 18, 2022

NEW YORK (Reuters Health) - HIV-positive kidney- and liver-transplant patients can expect good long-term outcomes following the transplant, comparable with those of matched HIV-negative peers, according to a new study.

"The findings support providing transplant to HIV-positive patients, which may be an appropriate use of transplant resources and provides equitable access for HIV-positive patients," write Dr. Arya Zarinsefat of the University of California, San Francisco (UCSF) and colleagues in JAMA Surgery.

Kidney transplant (KT) and liver transplant (LT) in HIV-positive patients have become more widely adopted, but data looking at long-term outcomes of patient and graft survival are lacking, they note.

The team turned to data from the UCSF transplant program to compare the long-term outcomes of 119 HIV-positive and 655 matched HIV-negative KT recipients and 80 HIV-positive and 440 matched HIV-negative LT recipients.

In the KT cohort, 15 years after transplant, patient survival was 53.6% in the HIV-positive and 79.6% in the HIV-negative recipients and graft survival was 75.0% and 57.0%, respectively. HIV infection was not associated with worse graft survival (hazard ratio, 1.09; 95% CI, 0.61 to 1.97).

The reduced long-term patient survival among the HIV-positive KT cohort likely relates to long-term cardiovascular HIV/AIDS-related comorbidities, the researchers say.

HIV-positive KT recipients with at least one episode of acute rejection had a graft survival of 52.8% at 15 years, compared with 91.8% in those without acute rejection. "The management and prevention of acute rejection in HIV-positive KT will therefore continue to be a key component in the care of these patients," the researchers write.

In the LT cohort, 15 years after transplantation, patient survival was 60.3% in the HIV-positive and 65.3% in the HIV-negative recipients. HIV infection was not a statistically significant predictor of patient survival (HR, 1.36; 95% CI, 0.83 to 2.24).

The study also showed improved outcomes in KT and LT since the advent of anti-hepatitis C virus (HCV) direct-acting agents. "Successful treatment of HCV coinfection was the last hurdle to achieve comparable results to the HIV-negative-transplant recipient," the researchers write.

"The findings, in combination with previously published work, support providing organ transplant to HIV-positive patients, which the study team believes is an appropriate use of transplant resources and provides equitable access to these resources for HIV-positive patients," they conclude.

The study had no commercial funding and the authors have disclosed no relevant conflicts of interest.

SOURCE: JAMA Surgery, online January 5, 2022.