HIV-Positive–to–HIV-Positive Liver Transplantation

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

“…Among centers planning HOPE protocols, overall knowledge of HIV D+/R+ transplants reported in the peer‐reviewed literature was high (Table ). Of respondents planning HOPE protocols, 54.5% correctly identified the number of HIV D+/R+ transplants that had been reported worldwide at the time of survey distribution (15‐45 HIV D+/R+ transplants were reported by 8 June 2016) and 58.0% correctly identified the estimated size of the HIV+ deceased organ donor pool each year (200‐600 potential HIV+ organ donors per year).…”

“…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.…”

HIV-positive to HIV-positive liver transplantation: To be continued

“…Although the recently reported outcomes of human immunodeficiency virus (HIV)-positive to HIV-positive liver transplantation (LT) performed in the UK and Switzerland are certainly promising, several challenges remain before this transplant option can be expanded. 1,2 The main risks of this procedure include: HIV superinfection, transmission of drug resistance and/or donor-related infections, drug-related liver dysfunction, and an increased risk of rejection.…”

Improving the outcomes of human immunodeficiency virus/hepatitis C virus–coinfected transplant recipients: The answer is Blowin’ in the wind

“…The only report of HIV/HCV‐to‐HIV/HCV liver transplantation (in the pre‐DAA era) should serve as a cautionary tale because the patient developed recurrent HCV viremia shortly after transplant and developed graft cirrhosis 3 years later. HCV infection was subsequently cured with DAAs . In another case of a HIV‐to‐HIV liver transplant, the recipient was HCV seropositive and experienced no untoward events or viral reactivation …”