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

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; HOPE in Action Investigators

doi:10.1111/ajt.16205

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

Am J Transplant. 2021 May;21(5):1754-1764. doi: 10.1111/ajt.16205. Epub 2020 Aug 8.

Authors

Christine M Durand¹, Wanying Zhang², Diane M Brown¹, Sile Yu², Niraj Desai², Andrew D Redd^{1

3}, Serena M Bagnasco⁴, Fizza F Naqvi¹, Shanti Seaman¹, Brianna L Doby¹, Darin Ostrander¹, Mary Grace Bowring², Yolanda Eby⁴, Reinaldo E Fernandez¹, Rachel Friedman-Moraco^{5

6}, Nicole Turgeon^{6

7}, Peter Stock⁸, Peter Chin-Hong⁸, Shikha Mehta⁹, Valentina Stosor¹⁰, Catherine B Small¹¹, Gaurav Gupta¹², Sapna A Mehta¹³, Cameron R Wolfe¹⁴, Jennifer Husson¹⁵, Alexander Gilbert¹⁶, Matthew Cooper¹⁶, Oluwafisayo Adebiyi¹⁷, Avinash Agarwal¹⁸, Elmi Muller¹⁹, Thomas C Quinn^{1

3}, Jonah Odim²⁰, Shirish Huprikar²¹, Sander Florman²¹, Allan B Massie², Aaron A R Tobian⁴, Dorry L Segev²; HOPE in Action Investigators

Affiliations

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 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.
⁶ Department of Surgery, Emory University, Atlanta, Georgia, USA.
⁷ Department of Surgery, Dell Medical School, University of Texas, Austin, Texas, USA.
⁸ Department of Medicine, University of California, San Francisco, California, USA.
⁹ Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁰ Department of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹¹ Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA.
¹² Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
¹³ NYU Langone Transplant Institute, New York University Grossman School of Medicine, New York, New York, USA.
¹⁴ Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
¹⁵ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹⁶ Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, District of Columbia, USA.
¹⁷ Department of Medicine, Indiana University Health Hospital, Indianapolis, Indiana, USA.
¹⁸ Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.
¹⁹ Department of Surgery, University of Cape Town, Cape Town, South Africa.
²⁰ Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
²¹ Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA.

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.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural

MeSH terms

Follow-Up Studies
Graft Rejection / etiology
Graft Survival
HIV Infections* / complications
Humans
Kidney Transplantation*
Pilot Projects
Prospective Studies
Risk Factors
Tissue Donors

Abstract

Publication types

MeSH terms

Grants and funding