Solid Organ Transplantation for HIV-Infected Individuals
Purpose of review
The prevalence of end-stage organ disease is increasing among HIV-infected (HIV+) individuals. Individuals with well-controlled HIV on antiretroviral therapy (ART), without active opportunistic infections or cancer, and with specified minimum CD4 cell counts are appropriate transplant candidates. Infectious disease clinicians can improve access to transplantation for these patients and optimize management pre- and post-transplant.
Clinical trials and registry-based cohort studies demonstrate excellent outcomes for select HIV+ kidney and liver transplant recipients with patient and graft survival similar to HIV-uninfected patients. Elevated allograft rejection rates have been observed in HIV+ individuals; this may be related to a dysregulated immune system, drug interactions, or both. Lymphocyte-depleting immunosuppression has been associated with lower rejection rates without increased infections using national registry data. Hepatitis C virus (HCV) co-infection has been associated with worse outcomes; however, improvements are expected with direct-acting antiviral therapies.
Solid organ transplantation should be considered for HIV+ individuals with end-stage organ disease. Infectious disease clinicians can optimize ART to avoid pharmacoenhancers, which interact with immunosuppression. The timing of HCV treatment (pre- or post-transplant) should be discussed with the transplant team. Finally, organs from HIV+ donors can now be considered for HIV+ transplant candidates, within research protocols.
KeywordsHIV infection Solid organ transplantation End-stage renal disease End-stage liver disease Kidney transplant Liver transplant Immunosuppression
The data reported here have been supplied in part by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR, the Organ Procurement and Transplantation Network (OPTN), or the US Government.
C.M.D. is supported by the National Cancer Institute grant K23CA177321-01A1, R34AI123023, U01AI134591.
A.A.S. is supported by the NIDDK grant F30DK116658-01.
Compliance with ethical standards
Conflict of interest
Ashton A. Shaffer declares that she has no conflict of interest.
Christine M. Durand has received research grants from Bristol Meyers Squibb, Gilead Sciences, Merck Pharmaceuticals, and Viiv Healthcare and has served as a scientific advisor for Bristol Meyers Squibb, Gilead Sciences, and Merck Pharmaceuticals.
Human and animal rights and informed consent
With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed.
References and Recommended Reading
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