by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
March 10, 2020
Chen C et al. Outcomes in Human Immunodeficiency Virus-Infected Recipients of Heart Transplants. Clin Transplant. 2019 Jan;33(1): e13440. doi: 10.1111/ctr.13440.
In the era of combination antiretroviral therapy (ART), growing evidence has shown that HIV infection is not a contraindication for solid organ transplantation. There have been positive outcomes reported in HIV-infected patients who have undergone liver or renal transplants but there is a paucity of data regarding heart transplant recipients (HTRs). This study compared the outcomes of heart transplantations in HIV-positive and HIV-negative recipients. The authors used data from the Scientific Registry of Transplant Recipients (SRTR). The SRTR includes information on all donors, wait-listed candidates, and transplant recipients in the U.S. based on submissions by members of the Organ Procurement and Transplantation Network (OPTN). All patients who received a heart transplant over the age of 18 were included in this analysis. The median age of the HIV group was 54 years and 71% were male. Median age in the HIV-negative group was 56 years and 75% were male. Patients were followed from date of transplantation until the end of year 5, graft failure, re-transplantation, or death. Patient survival, overall graft survival and death-censored graft survival were compared between HIV-positive and HIV-negative recipients. From 2004-2016, there were 35 HIV-infected persons who underwent a heart transplant and 21,400 HIV-negative heart transplant recipients. There were no significant differences in patient survival (88% vs 77%) or overall graft survival (85% vs 76%) between HIV-positive and HIV-negative HTRs in 5-years of follow-up. This study supports the use of heart transplants in medically appropriate HIV-positive patients.
Although the number of HTRs in this study is relatively small at 35 the data is very favorable. Of note, more than half of the HIV-positive patients in this study underwent heart transplantation from 2014-2016, possibly as a result of the HIV Organ Policy Equity (HOPE) act. This Act was passed in 2013 and finalized by the DHHS and NIH in 2015 noting safeguards and research criteria for transplantation of HIV-positive donor organs in HIV-positive recipients. The prospective goal of the HOPE act is to increase knowledge regarding the safety, efficacy, and effectiveness of organ transplantation utilizing HIV-positive donors in HIV-positive recipients. I suspect many of our clinical practices have HIV-infected patients who have undergone liver or kidney transplants and are doing well.
Dept of Health and Human Services/ National Institutes of Health. Final Human Immunodeficiency Virus (HIV) Organ Policy Equity (HOPE) Act Safeguards and Research Criteria for Transplantation of Organs Infected With HIV. Federal Register / Vol. 80, No. 227 / Wednesday, November 25, 2015 / Notices
The author has no conflicts of interest to disclose.
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