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Organ Transplantation and HIV Progress or Success? A Review of Current Status

  • HIV/AIDS (R MacArthur, Section Editor)
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Abstract

Advancements in the scientific understanding of human immunodeficiency virus (HIV) and care of those afflicted have progressed to make HIV a chronic disease and significantly extend the lives of HIV patients. Subsequently, an aging population has emerged, with the conditions inherent with advanced years, including organ failure. Organ transplantation is an accepted modality for organ failure; however, it was felt to be contraindicated in HIV patients because HIV was an ultimately fatal condition that would be hastened by additional immune suppression. Highly active antiretroviral therapy has dramatically altered that mind-set. After limited early experience and a recent large national trial, HIV organ transplantation has gained a degree of acceptance. This article will review the progress and unresolved issues.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Pneumocystis Pneumonia—Los Angeles. CDC Morbidity and Mortality Weekly Report. June 5, 1981; 30(21).

  2. Weiss SH, Goedert JJ, Sarngadharan MG, et al. Screening test for HTLV-III (AIDS Agent) antibodies. Specificity, sensitivity, and applications. JAMA. 1985;253:221–5.

    Article  PubMed  CAS  Google Scholar 

  3. Palella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infections. N Eng J Med. 1998;338(13):853–60.

    Article  Google Scholar 

  4. D:A:D Study. Liver-related deaths in persons infected with the human immunodeficiency virus. Arch Intern Med. 2006;166:1632–41.

    Article  Google Scholar 

  5. Thio CL, Seaberg EC, Skolasky Jr R, et al. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet. 2002;360:1921–6.

    Article  PubMed  Google Scholar 

  6. Lesens O, Deschenes M, Steben M, et al. Hepatitis C virus is related to progressive liver disease in human immunodeficiency virus—positive hemophiliacs and should be treated as an opportunistic infection. J Inf Dis. 1999;179:1254–8.

    Article  CAS  Google Scholar 

  7. Bica I, McGovern B, Dhar R, et al. Increasing mortality due to end-stage liver disease in patients with human immunodeficiency virus infection. Clin Inf Dis. 2001;32:492–7.

    Article  CAS  Google Scholar 

  8. Reisler RB, Han C, Burman WJ, et al. Grade 4 events in the era of HAART. J Aquir Immune Defic Syndr. 2003;34:379–86.

    Article  Google Scholar 

  9. Fine DM, Perazella MA, Lucas GM, et al. Renal disease in patient with HIV infection. Drugs. 2008;68:963–80.

    Article  PubMed  CAS  Google Scholar 

  10. Kalayjian RC, Lau B. Mechekano et al.: Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care. AIDS. 2012;26:1907–15.

    Article  PubMed  CAS  Google Scholar 

  11. Sreepada RTK, Friedman EA, Nicastri AD. The types of renal disease in the acquired immunodeficiency syndrome. N Engl J Med. 1987;16:1062–8.

    Google Scholar 

  12. Ortiz C, Meneses R, Jaffe D, et al. Outcome of patients with human immunodeficiency virus on maintenance hemodialysis. Kidney Int. 1988;34:248–53.

    Article  PubMed  CAS  Google Scholar 

  13. Perinbasekar S, Brod-Miller C, Pal S, et al. Predictors of survival in HIV-infected patients on hemodialysis. A J Nephro. 1996;16:280–6.

    Article  CAS  Google Scholar 

  14. Ahuja TS, Borucki M, Grady J. Highly active antiretroviral therapy improves survival of HIV-infected hemodialysis patients. A J Kid Dis. 2000;36:574–81.

    Article  CAS  Google Scholar 

  15. Spengler U. Management of end-stage liver disease in HIV/hepatitis C virus co-infection. Cur Opin HIV AIDS. 2011;6:527–33.

    Article  Google Scholar 

  16. Rubin RH, Jenkins RL, Shaw BW, et al. The acquired immunodeficiency syndrome and transplantation. Transplantation. 1987;44:1–4.

    Article  PubMed  CAS  Google Scholar 

  17. Rubin RH, Tokoff-Rubin NE. The problem of human immunodeficiency virus (HIV) infection and transplantation. Transplant Int. 1988;1:36–42.

    Article  CAS  Google Scholar 

  18. Boyd AS. Organ Transplantation in HIV positive patients. N Eng J Med. 1990; 1492.

  19. Ciuffreda D, Pantaleo G, Pascua M. Effects of immunosuppressive drugs on HIV infection: implications for solid-organ transplantation. Transplant Int. 2007;20:649–58.

    Article  CAS  Google Scholar 

  20. Schwarz A, Offermann G, Keller F, et al. The effect of cyclosporine on the progression of human immunodeficiency virus type 1 infection transmitted by transplantation—data on four cases and review of the literature. Transplantation. 1993;55:95–103.

    Article  PubMed  CAS  Google Scholar 

  21. Human immunodeficiency virus infection transmitted from an organ donor screened for HIV antibody-North Carolina. MMWR. 1987; 36:306–308.

  22. Feduska NJ, Perkins HA, Melzer J, et al. Observations relating to the incidence of AIDS and other possibly associated conditions in a large population of renal transplant recipients. Transplant Proc. 1987;19:2161–6.

    PubMed  CAS  Google Scholar 

  23. Kumar P, Pearson JE, Martin DH, et al. Transmission of human immunodeficiency virus by transplantation of a renal allograft with development of the acquired immunodeficiency syndrome. Ann Intern Med. 1987;106:244–5.

    PubMed  CAS  Google Scholar 

  24. L’Age-Stehr J, Schwarz A, Offermann G, et al. HTLV-III infection in kidney transplant recipients. Lancet II. 1985;1261.

  25. Margreiter R, Fuchs D, Hansen A, et al. HIV infection in renal allograft recipients. Lancet II. 1986; 398.

  26. Milgrom M, Esquenazi V, Fuller L, et al. Acquired immunodeficiency syndrome in a transplant patient. Transplant Proc. 1985;17 Suppl 2:75–6.

    Google Scholar 

  27. Oliveira DBG, Winearls CG, Cohen J, et al. Severe immunosuppression in a renal transplant recipient with HTLV-III antibodies. Transplantation. 1986;41:260–2.

    Article  PubMed  CAS  Google Scholar 

  28. Prompt CA, Reis MM, Grillo FM, et al. Transmission of AIDS virus at renal transplantation. Lancet II. 1986; 672.

  29. Shaffer D, Pearl RH, Jenkins RL, et al. HTLV-III/LAV infection in kidney and liver transplantation. Transplant Proc. 1987;19:2176–80.

    PubMed  CAS  Google Scholar 

  30. Poli F, Scalamogna M, Pizzi C, et al. HIV Infection in Cadaveric renal allograft recipients in the North Italy transplant program. Transplantation. 1989;47:724–5.

    Article  PubMed  CAS  Google Scholar 

  31. Tzakis AG, Cooper MH, Dummer S, et al. Transplantation in HIV + patients. Transplantation. 1990;49:354–8.

    Article  PubMed  CAS  Google Scholar 

  32. Erice A, Rhame FS, Heussner RC, et al. Human immunodeficiency virus infection in patients with solid-organ transplants: report of five cases and review. Rev Inf Dis. 1991;13:537–47.

    Article  CAS  Google Scholar 

  33. Swanson SJ, Kirk AC, Ko CW, et al. Impact of HIV seropositivity on graft and patient survival after cadaveric renal transplantation in the United States in the pre highly active antiretroviral therapy (HAART) era: an historical cohort analysis of the United States Renal Data System. Transpl Inf Dis. 2002;4:144–7.

    Article  CAS  Google Scholar 

  34. Ahuja TS, Zingman B, Glicklich D. Long-term survival in an HIV infected renal transplant recipient. Am J Nephro. 1997;17:480–2.

    Article  CAS  Google Scholar 

  35. Antiretroviral therapy cohort collaboration. Life expectancy of individuals on combination antiretroviral therapy in high –income countries; a collaborative analysis of 14 cohort studies. Lancet. 2008;372:293–9.

    Article  Google Scholar 

  36. Roland ME, Carlson L, Ragni M, et al. Solid organ transplantation in HIV-infected recipients: forty-seven cases in the HAART era. Int Conf AIDS. 2002 Jul 7–1;14: abstract MoOrB1060.

  37. Spital A. Should all human immunodeficiency virus-infected patients with end-state renal disease be excluded from transplantation: the views of U.S. transplant center. Transplantation. 1998;651:1187–91.

    Article  Google Scholar 

  38. Halpern SD, Asch DA, Shaked A. Determinants of transplant surgeon’s willingness to provide organs to patients infected with HBV. HCV or HIV A J Transplant. 2005;5:1319–25.

    Article  PubMed  Google Scholar 

  39. Halpern SC, Ubel PA, Caplan AL. Solid-organ transplantation in HV infected patients. N Engl J Med. 2002;347:284–7.

    Article  PubMed  Google Scholar 

  40. Abbott KC, Swanson SJ, Agodoa LYC. Human immunodeficiency virus infection and kidney transplantation in the era of highly active antiretroviral therapy and modern. J Am Soc Nephro. 2004;15:1633–9.

    Article  Google Scholar 

  41. Sawinski D, Wyatt CM, Casagrande L, et al. Factors associated with failure to list HIV positive kidney transplant candidates. A J Transplant. 2009;9:1467–71.

    Article  CAS  Google Scholar 

  42. Calabrese LH, Albrecht M, Young J, et al. Successful cardiac transplantation in an HIV 1 infected patient with advanced disease. N Engl J Med. 2003;348:2323–8.

    Article  PubMed  Google Scholar 

  43. Uriel N, Jorde UP, Cotarlan V, et al. Heart transplantation in human immunodeficiency virus-positive patients. J Heart Lung Transplant. 2009;28:667–9.

    Article  PubMed  Google Scholar 

  44. Grossi PA, Righi E, Gasperina DD, et al. Report of four simultaneous pancreas—kidney transplants in HIV positive recipients with favorable outcome. A J Transplant. 2012;12:1039–45.

    Article  CAS  Google Scholar 

  45. Krishnan A. Stem cell transplantation in HIV infected patients. Cur Opin HIV AIDS. 2009;4:11–5.

    Article  Google Scholar 

  46. Izzedine H, Launay-Vacher V, Baumelou A, et al. Antiretroviral and immunosuppressive drug-drug interactions: an update. Kidney Int. 2004;66:532–41.

    Article  PubMed  CAS  Google Scholar 

  47. Frassetto LA, Browne M, Cheng A, et al. Immunosuppressant pharmacokinetics and doing modifications in HIV-1 infected liver and kidney transplant recipients. A J Transplant. 2007;7:2816–20.

    Article  CAS  Google Scholar 

  48. Marfo K, Greenstein S. Antiretroviral and immunosuppressive drug-drug interactions in human immunodeficiency virus—infected liver and kidney transplant recipients. Transplant Proc. 2009;41:3796–9.

    Article  PubMed  CAS  Google Scholar 

  49. Cousins D, Topping K, Lee V, et al. Successful tacrolimus treatment following renal transplant in a HIV infected patient with raltegravir previously treated with a protease inhibitor based regimen. Drug Meta Drug Interact. 2011;26:139–41.

    Google Scholar 

  50. Tricot L, Teicher E, Peytavin G, et al. Safety and efficacy of raltegravir in HIV–infected transplant patients cotreated with immunosuppressive drugs. A J Transplant. 2009;9:2946–52.

    Google Scholar 

  51. Moreno A, Perez-Elias MJ, Casado JL, et al. Raltegravir-based highly active antiretroviral therapy has beneficial effects on the renal function of human immunodeficiency virus-infected patents after solid organ transplantation. Liver Transpl. 2010;16:530–2.

    PubMed  Google Scholar 

  52. Stock PG, Roland ME, Carlson L, et al. Kidney and liver transplantation in human immunodeficiency virus infected patients: a pilot safety and efficacy study. Transplantation. 2003;76:370–5.

    Article  PubMed  Google Scholar 

  53. Qiu J, Terasaki PI, Waki K, et al. HIV positive renal recipients can achieve survival rates similar to those of HIV negative patients. Transplantation. 2006;81:1658–61.

    Article  PubMed  Google Scholar 

  54. Anil Kumar MS, Sierka DR, Damask AM, et al. Safety and success of kidney transplantation and concomitant immunosuppression in HIV positive patients. Kidney Int. 2005;67:1622–9.

    Article  Google Scholar 

  55. Yoon SC, Hurst FP, Jindal RM, et al. Trends in renal transplantation in patients with human immunodeficiency virus infection: an analysis of the United States renal data system. Transplantation. 2011;91:864–8.

    Article  PubMed  Google Scholar 

  56. •• Stock PG, Barin B, Murphy B, et al. Outcomes of kidney transplantation in HIV infected recipients. N Engl J Med. 2010;363:2004–14. The largest prospective trial of 150 renal transplants, demonstrating comparable outcomes to all renal recipients and recipients > 65.

    Article  PubMed  CAS  Google Scholar 

  57. Locke JE, Montgomery RA, Warren DS. Renal transplant in HIV positive patients. Long-term outcomes and risk factors for graft loss. Arch Surg. 2009;144:83–6.

    Article  PubMed  Google Scholar 

  58. Gruber SA, Doshi MD, Cincotta E, Brown KL, Singh A, et al. Preliminary experience with renal transplantation in HIV + recipients: low acute rejection ad infection rates. Transplantation. 2008;86:269–74.

    Article  PubMed  Google Scholar 

  59. • Landin L, Rodriguez-Perez JC, Garca-Bello MA. Kidney transplants in HIV positive recipients under HAART. A comprehensive review and meta-analysis of 12 series. Nephro Dial Transplant. 2010;25:3106–15. A meta-analysis providing a broader picture of renal transplantation in the HAART era.

    Article  CAS  Google Scholar 

  60. Martina MN, Cofan F, Suarez A, et al. Kidney transplantation and waiting list for renal transplantation for human immunodeficiency virus patients. Transplant Proc. 2011;43:2179–81.

    Article  PubMed  CAS  Google Scholar 

  61. • Mazuecos A, Fernandez A, Andres A, et al. HIV infection and renal transplantation. Nephro Dial Transplant. 2011;26:1401–7. A small case-controlled matched cohort of renal transplants with good outcome, but noting the challenges of HCV coinfection.

    Article  Google Scholar 

  62. Trullas JC, Mocroft A, Cofan F. Dialysis and renal transplantation in HIV-infected patients: a European survey. J Acquir Immune Defic Syndr. 2010;55:582–9.

    Article  PubMed  Google Scholar 

  63. Touzot M, Pillebout E, Matignon M, et al. Renal transplantation in HIV-infected patients: the Paris experience. A J Transplant. 2010;10:2263–9.

    Article  CAS  Google Scholar 

  64. Mazuecos A, Fernandez A, Andres A, et al. Kidney transplantation outcomes in HIV infection: the European experience. A J Transplant. 2011;11:635–6.

    Article  CAS  Google Scholar 

  65. Kamath PS, Wiesner RH, Malinchoc M. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–70.

    Article  PubMed  CAS  Google Scholar 

  66. Ragni MV, Eghtesad B, Schlesinger KW, et al. Pretransplant survival is shorter in HIV-positive than HIV-negative subjects with end-stage liver disease. Liver Transpl. 2005;11:1425–30.

    Article  PubMed  Google Scholar 

  67. Pineda JA, Romero-Gomez M, Diaz-Garcia F, et al. HIV coinfection shortens the survival of patients with hepatitis C virus-related decompensated cirrhosis. Hepatology. 2005;41:779–89.

    Article  PubMed  Google Scholar 

  68. Stock PG. Rapid deterioration of HIV co-infected patients waiting for liver transplantation is not predicted by MELD. Liver Transpl. 2005;11:1315–7.

    Article  PubMed  Google Scholar 

  69. • Subramanian A, Sulkowski M, Barin B, et al. MELD Score is an important predictor of pretransplantation mortality in HIV-infected liver transplant candidates. Gastroenterology. 2010;138:159–64. This article validates the use of MELD in HIV patients ending an ongoing debate.

    Article  PubMed  Google Scholar 

  70. Neff GW, Bonham A, Tzakis AG, et al. Orthotopic liver transplantation in patients with human immunodeficiency virus and end-stage liver disease. Liver Transpl. 2003;9:239–47.

    Article  PubMed  Google Scholar 

  71. Norris S, Taylor C, Muiesan P, et al. Outcome of liver transplantation in HIV-infected individuals: the impact of HCV and HBV infection. Liver Transpl. 2004;10:1271–8.

    Article  PubMed  Google Scholar 

  72. Roland ME, Barin B, Carlson L, et al. HIV-Infected liver and kidney transplant recipients: 1- and 3-Year outcomes. A J Transplant. 2008;8:355–65.

    Article  CAS  Google Scholar 

  73. Di Benedetto F, Tarantino G, De Ruvo N, et al. University of Modena experience in HIV-positive patients undergoing liver transplantation. Transplant Proc. 2011;43:1114–8.

    Article  PubMed  Google Scholar 

  74. • Baccarani U, Adani GL, Braganini F, et al. Long-term outcomes of orthotopic liver transplantation in human immunodeficiency virus-infected patients and comparison with human immunodeficiency virus-negative cases. Transplant Proc. 2011;43:1119–22. A comparison of HIV-positive and -negative liver recipients, showing similar outcomes in Italy.

    Article  PubMed  CAS  Google Scholar 

  75. •• Miro JM, Montejo M, Castells L, et al. Outcome of HCV/HIV-coinfected liver transplant recipients: a prospective and multicenter cohort study. A J Transplantation. 2012;12:1866–76. A large prospective matched study of liver transplants in Spain with higher rejection and mortality in HIV-positive patients. The study delineated factors impacting outcomes.

    Article  CAS  Google Scholar 

  76. Moreno A, Cervera C, Fortun J, et al. Epidemiology and outcome of infections in human immunodeficiency virus/hepatitis C virus-coinfected liver transplant recipients: a FIPSE/GESIDA prospective cohort study. Liver Transpl. 2012;18:70–82.

    Article  PubMed  Google Scholar 

  77. Douclos-Vallee J-C, Tateo M, Teicher E. Results of liver transplantation in a large cohort of more than 200 HIV infected patients –A monocentric experience. Hepatology. 2011;54(suppl):361A.

    Google Scholar 

  78. Teicher E, Duclos-Vallee J-C. Opportunistic infections after liver transplantation in patients infected with human immunodeficiency virus. Liver Transpl. 2012;18:376–7.

    Article  PubMed  Google Scholar 

  79. Kemmer NM, Sherman KE. Liver transplantation trends in the HIV population. Dig Dis Sci. 2011;56:3393–8.

    Article  PubMed  Google Scholar 

  80. • Cooper C, Kanters S, Klein M, et al. Liver transplant outcomes in HIV-infected patients: a systemic review and meta-analysis with synthetic cohort. AIDS. 2011;25:777–86. A meta-analysis of HAART era liver transplantation largely focused on Europe and the U.S., noting excellent HBV liver transplant outcomes and near universal HCV recurrence.

    Article  PubMed  Google Scholar 

  81. •• Terrault NA, Roland ME, Schiano T, et al. Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection. Liver Transplant. 2012;18:716–26. HCV outcome in liver transplants from the largest prospective trial outlining factors responsible for decreased survival.

    Article  Google Scholar 

  82. Tateo M, Roique-Afonso A-M, Antonini TM, et al. Long-term follow-up of liver transplanted HIV/hepatitis B virus coinfected patients: perfect control of hepatitis B virus replication and absence of mitochondrial toxicity. AIDS. 2009;23:1069–76.

    Article  PubMed  Google Scholar 

  83. • Coffin CS, Stock PG, Dove LM, et al. Virologic and clinical outcomes of hepatitis B virus infection in HIV-HBV coinfected transplant recipients. A J Transplant. 2010;10:1268–75. Prospective North American HBV coinfected cohort noting similar very good outcome to HIV-negative liver recipients.

    Article  CAS  Google Scholar 

  84. Hughes CB, Dickson RC, Krisna M, et al. HCV recurrence in HIV-infected patients after liver transplant. J Int Ass Phys AIDS Care. 2010;9:87–93.

    Article  Google Scholar 

  85. De Vera ME, Dvorchik I, Tom K, et al. Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. A J Transplant. 2006;6:2983–93.

    Article  Google Scholar 

  86. Duclos-Vallee J-C, Feray C, Sebagh M, et al. Survival and recurrence of hepatitis C after liver transplantation in patients coinfected with human immunodeficiency virus and hepatitis C virus. Hepatology. 2008;47:407–17.

    Article  PubMed  CAS  Google Scholar 

  87. Di Benedetto FD, DeRuvo N, Berretta M, et al. Hepatocellular carcinoma in HIV patients treated by liver transplantation. EJSO. 2008;34:422–7.

    Article  PubMed  Google Scholar 

  88. Baccarani Um Adani GL, Tavio M, et al. Liver transplantation for Hepatocellular carcinoma: the impact of human immunodeficiency virus infection −21 plus 13. Am Ass Study Liver Dis. 2011; 2138.

  89. • Muller E, Kahn D, Mendelson M. Renal transplantation between HIV positive donors and recipients. N Engl J Med. 2010;362:2336–7. The first case reports of HIV donor and recipient positive renal transplants.

    Article  PubMed  CAS  Google Scholar 

  90. Davies J. Elmi Muller: bending rules, changing guidelines, making history. Lancet. 2012;379:1781.

    Article  PubMed  Google Scholar 

  91. • Boyarsky BJ, Hall EC, Singer AL. Estimating the potential pool of HIV infected deceased organ donors in the United States. A J Transplant. 2011; doi:10.1111/j.1600-6143.2011.03506.X. A study estimating the number of potential HIV-positive donors that could be used for HV-positive recipients, thus helping to alleviate the shortage of organs for transplantation.

  92. Bhagat V, Foont JA, Schiff ER, et al. Spontaneous clearance of hepatitis C virus after liver transplantation in two patients coinfected with hepatitis C virus and human immunodeficiency virus. Liver Transpl. 2008;14:92–5.

    Article  PubMed  Google Scholar 

  93. Frisch M, Biggar RJ, Engels EA, et al. Association of cancer with AIDS-related immunosuppression in adults. JAMA. 2001;285:1736–45.

    Article  PubMed  CAS  Google Scholar 

  94. Cobucci RNO, Saconato H, Lima PH, et al. Comparative incidence of cancer in HIV-AIDS patients and transplant recipients. Cancer Epidemiol. 2012;36:e69–73.

    Article  Google Scholar 

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  1. Department of Infectious Diseases, Cleveland Clinic, 9500 Euclid Ave / G-21, Cleveland, OH, 44195, USA

    Alan Taege

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Taege, A. Organ Transplantation and HIV Progress or Success? A Review of Current Status. Curr Infect Dis Rep 15, 67–76 (2013). https://doi.org/10.1007/s11908-012-0309-x

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