HIV-Positive-to-HIV-Positive Liver Transplantation

Knowledge, attitudes, and planned practice of HIV‐positive to HIV‐positive transplantation in US transplant centers

“…The survey consisted of 26 items regarding participant specialty/role, number of HIV+ candidates on their waitlist, center opinions on the HHS safeguards and research criteria, perceptions of HIV+ waitlist candidates at their center, planned practice of HIV D+/R+ transplants, and perceived risk of HIV D+/R+ transplants. The survey also included five multiple‐choice and true/false‐style questions assessing knowledge of HIV D+/R+ transplants (awareness that HIV D+/R+ transplants are legal, awareness that HIV D+/R+ transplants are limited to research, awareness of the HHS HOPE Safeguards and Research Criteria, knowledge of the number of HIV D+/R+ transplants done worldwide, and knowledge of the estimated size of the annual HIV+ deceased donor organ pool), and six multiple‐choice questions assessing knowledge of HIV‐uninfected donor to HIV‐infected (HIV D−/R+) transplants (impact of center experience, NIH study participation, and transplant era [2004‐2007 and 2008‐2011] on outcomes as published in the literature, and risk of acute rejection, graft survival, and patient survival in HIV D−/R+ transplants compared to HIV D−/R− transplants as published in the literature) (Appendix S1). The survey was pilot tested by two transplant surgeons, an infectious disease physician, and a statistician, and was revised based on feedback prior to distribution.…”

“…Successful implementation of HIV D+/R+ transplantation requires that transplant centers are appropriately informed and prepared for this practice. This includes knowing: that HIV D+/R+ transplants are legal and limited to research protocols, the estimated size of the annual HIV+ deceased donor organ pool, the number of HIV D+/R+ transplants performed worldwide, reported outcomes for HIV D−/R+ transplants, and awareness of the HHS HOPE Safeguards and Research Criteria . The enactment of federally mandated criteria for research protocols is unprecedented in solid organ transplantation, and disagreement with criteria could limit implementation.…”

Advancing Transplant Care in AIDS: Encouraging Innovation in Transplantation

“…Within this context, we welcome the report of a successful deceased donor liver transplant from a 75-yearold HIV-positive donor into a 53-year-old HIV-positive recipient in October 2015 by a team in Geneva, Switzerland (6). Remarkably, both the donor and the recipient had long-standing HIV infection, with diagnoses in 1989 and 1987, respectively.…”

Donor‐derived infections and infectious risk in xenotransplantation and allotransplantation

“…Despite the presence of multiple HIV strains in the recipient, meticulous antiviral management has prevented the emergence of treatment resistance and reactivation despite immunosuppression. The status of tissue‐specific latent HIV reservoirs is unknown . This suggests that, in the setting of viruses for which antiviral therapies exist, successful transplantation may be performed without viral reactivation—but that longer‐term data will be required.…”