HOPE in action: A prospective multicenter pilot study of liver transplantation from donors with HIV to recipients with HIV

Abstract

Liver transplantation (LT) from donors‐with‐HIV to recipients‐with‐HIV (HIV D+/R+) is permitted under the HOPE Act. There are only three international single‐case reports of HIV D+/R+ LT, each with limited follow‐up. We performed a prospective multicenter pilot study comparing HIV D+/R+ to donors‐without‐HIV to recipients‐with‐HIV (HIV D−/R+) LT. We quantified patient survival, graft survival, rejection, serious adverse events (SAEs), human immunodeficiency virus (HIV) breakthrough, infections, and malignancies, using Cox and negative binomial regression with inverse probability of treatment weighting. Between March 2016–July 2019, there were 45 LTs (8 simultaneous liver‐kidney) at 9 centers: 24 HIV D+/R+, 21 HIV D−/R+ (10 D− were false‐positive). The median follow‐up time was 23 months. Median recipient CD4 was 287 cells/µL with 100% on antiretroviral therapy; 56% were hepatitis C virus (HCV)‐seropositive, 13% HCV‐viremic. Weighted 1‐year survival was 83.3% versus 100.0% in D+ versus D− groups (p = .04). There were no differences in one‐year graft survival (96.0% vs. 100.0%), rejection (10.8% vs. 18.2%), HIV breakthrough (8% vs. 10%), or SAEs (all p > .05). HIV D+/R+ had more opportunistic infections, infectious hospitalizations, and cancer. In this multicenter pilot study of HIV D+/R+ LT, patient and graft survival were better than historical cohorts, however, a potential increase in infections and cancer merits further investigation.

Successful living donor liver transplantation from an HIV and HCV positive donor: report from the first case in the world

“…In line with this evidence, many concepts changed in the field of liver transplantation. Indeed, deceased donors with HCV and/or HIV have been considered suitable for transplant and transplanted in both recipients HCV and/ or HIV positive and HCV and/or HIV negative [12][13][14][15]. Moreover, a first successful case of living donor liver transplantation performed in South Africa from an HIVpositive mother to her HIV-negative child was already reported in 2016 [16].…”

Impact of sustained viral response for hepatitis C virus on the outcomes of liver transplantation in hemophilic patients with human immunodeficiency virus/hepatitis C virus co‐infection: A nationwide survey in Japan

“…[30][31][32][33] More recently, even HIV-positive donor livers have been successfully transplanted to HIV-positive recipients with the aid of DAA therapy. 34 Only one patient experienced breakthrough HIV infection after successful LT. Based on this encouraging result, in the future, marginal deceased donors (e.g., HIV-positive donors) could be used for this life-saving procedure in Japan. In such cases, we will have to monitor the graft liver using various reported markers of liver fibrosis, scores, and special ultrasound examinations to prevent refibrosis leading to graft failure.…”

“…More recently, even HIV‐positive donor livers have been successfully transplanted to HIV‐positive recipients with the aid of DAA therapy 34 . Only one patient experienced breakthrough HIV infection after successful LT. Based on this encouraging result, in the future, marginal deceased donors (e.g., HIV‐positive donors) could be used for this life‐saving procedure in Japan.…”

Donors with human immunodeficiency virus and hepatitis C virus for solid organ transplantation: what's new

“…HHV8 infection has a higher prevalence in PLWH and can be exacerbated in transplant recipients due to immunosuppression [39,40]. HIV breakthrough occurred in 2 D+ and 2 D- recipients, but was linked to ART nonadherence, rather than donor-derived HIV superinfection [36 ▪▪ ,37 ▪ ]. Although these results are encouraging, further research is needed to understand recipient infections and analyze survival benefit.…”