1. Among patients infected with human immunodeficiency virus (HIV) who receive a kidney transplant from a deceased donor, kidneys from HIV-infected donors are less likely to be infected with HIV in overall safety outcomes. No donor was inferior.
2. The incidence of HIV infection was higher in recipients of kidneys from HIV-infected donors.
Evidence evaluation level: 1 (great)
Research overview: Kidney transplantation is a lifesaving procedure for patients with end-stage renal disease. People with HIV who receive dialysis have less access to transplants than people without HIV, despite their increased risk of death. Organ transplants from people infected with HIV were banned before new laws and research recommendations emerged. Early observational evidence, although limited, showed promising results in kidney transplants from HIV-positive donors to HIV-positive recipients. This was an observational study comparing kidney transplants from HIV-infected and HIV-uninfected deceased donors to HIV-infected individuals. Transplants from HIV-positive donors were noninferior to transplants from HIV-negative donors in overall safety outcomes. Survival and graft loss outcomes at 1 year were also comparable. The incidence of breakthrough HIV infection is higher in recipients of kidney transplants from HIV-positive donors, including one potential HIV co-infection, with continued antiviral treatment. It never failed. This study was limited by its inherent nonrandomized design and heterogeneous immunosuppressive regimen. Nevertheless, these results provide evidence that kidney transplantation from HIV-infected donors to HIV-infected recipients is non-inferior and should provide guidelines to improve access to this patient population. It may be helpful.
Click here to read the NEJM study
Related books: Kidney transplantation from an HIV-positive person to an HIV-positive person—results after 3 to 5 years
detail [randomized controlled trial]: This was a multicenter observational study across 26 sites in the United States comparing kidney transplants from deceased HIV-positive and HIV-negative donors to HIV-infected recipients. Individuals 18 years of age or older whose HIV is well controlled on antiretroviral therapy, who have end-stage renal disease, who meet local kidney transplant criteria, and who agree to donate a kidney from an HIV-infected donor. Targeted people who did. Exclusion criteria included active opportunistic infections, history of progressive multifocal leukoencephalopathy, and central nervous system lymphoma. Participants were eligible to receive a kidney from the first available donor, regardless of HIV infection, according to national Organ Procurement and Transplant Network guidelines. The primary outcome was a composite of death from any cause, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment (>90 days), or opportunistic infection. A total of 408 transplant candidates were enrolled, and 198 recipients ultimately received kidneys from HIV-infected and uninfected individuals in a 1:1 ratio. The adjusted hazard ratio for the primary outcome was 1.00 (95% confidence interval). [CI] 0.73-1.38), indicating non-inferiority. Secondary outcomes were also comparable between the two recipient groups (HIV-infected and non-HIV donors): overall survival at 1 year (94% vs. 95%) and overall survival at 3 years (85% vs. 87%), 1 Graft loss-free survival after 1 year (93% vs. 90%) and 3 years (84% vs. 81%), rejection after 1 year (13% vs. 21%) and 3 years ( 21% vs. 24%). Rates of serious adverse events (75% vs. 77%), opportunistic infections (8% vs. 7%), and cancer (8% vs. 6%) were also similar between the two groups. Of note, HIV breakthrough infections occurred more frequently in the HIV-positive donor group (10%) than in the HIV-negative donor group (4%) (incidence rate ratio 3.14, 95% CI 1.02-9.63); There was one case of potential HIV co-infection. These results provided strong evidence that kidney transplantation from HIV-infected donors to HIV-infected recipients is non-inferior compared with HIV-uninfected donors. .
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