Long-term Outcomes Following Kidney and Liver Transplant in Recipients With HIV

Abstract

IMPORTANCE Kidney transplant (KT) and liver transplant (LT) in HIV-positive patients have become more widely adopted. Data looking at long-term outcomes of patient and graft survival are lacking.OBJECTIVE To compare the long-term outcomes of KT and LT in HIV-positive recipients with matched HIV-negative recipients.DESIGN, SETTING, AND PARTICIPANTS Retrospective, single-center, cohort, study using data from 2000 to 2019. Patients were observed until death, or graft failure requiring retransplant. All HIV-positive patients who underwent KT and/or LT between 2000 and 2019 were included. Propensity matching was performed to the corresponding HIV-negative cohort, which was obtained from the University of California, San Francisco's transplant recipient registry. The data were analyzed from 2020 to 2021. EXPOSURES HIV infection. MAIN OUTCOMES AND MEASURESPatient and graft survival for KT and patient survival for LT. Incidence of acute rejection and its association with KT graft survival. RESULTS For KT, 655 HIV-negative recipients (mean [SD] age, 52.3 [13.6] years; 450 [68.7%] were men) and 119 HIV-positive recipients (mean [SD] age, 51.7 [9.4] years; 86 [72.3%] were men) were included. Patient survival was 79.6% (95% CI, 73.6%-86.1%) and 53.6% (95% CI, 38.9%-74.0%) at 15 years posttransplant, respectively. Graft survival was 57.0% (95% CI, 47.8%-68.0%) and 75.0% (95% CI, 65.3%-86.2%) at 15 years posttransplant, respectively. Diagnosis of HIV was not associated with worse graft survival (hazard ratio, 1.09; 95% CI, 0.61-1.97; P = .77). For LT, 80 HIV-positive recipients (mean [SD] age, 52.6 [8.2] years; 53 [66.3%] were men) and 440 HIV-negative recipients (mean [SD] age, 54.6 [12.8] years; 291 [66.1%] were men) were included. Patient survival was 75.7% (95% CI, 71.8%-79.8%) for HIV-negative LT recipients and 70.0% (95% CI, 60.6%-80.8%) for HIV-positive LT recipients at 15 years posttransplant. Diagnosis of HIV was not a statistically significant predictor of patient survival (hazard ratio, 1.36; 95% CI, 0.83-2.24; P = .22). In KT, HIV-positive patients with at least 1 episode of acute rejection had a graft survival of 52.8% (95% CI, 38.4%-72.5%; P < .001) at 15 years posttransplant, compared with 91.8% in those without AR. CONCLUSIONS AND RELEVANCEIn this single-center cohort study, KT and LT in HIV-positive patients had comparable long-term outcomes with those in matched HIV-negative patients. The high incidence of acute rejection was associated with reduced graft survival. The findings support providing transplant to HIV-positive patients, which may be an appropriate use of transplant resources and provides equitable access for HIV-positive patients.

Expanding Access to Organ Transplant for People Living With HIV: Can Policy Catch Up to Outcomes Data?

“…[38][39][40] The advent of DAAs for the treatment of HCV has allowed successful eradication of HCV in patients who are co-infected, 45 such that the gap between survival outcomes in patients with and without HIV has narrowed over the last decade 42,43 and even disappeared post-2015 in some analyses. 46,98 PLWH appear to have similar long-term graft and patient survivals after liver transplant as patients without HIV, 72 including patients with hepatocellular carcinoma. 99 Outcomes of heart and lung transplantation in PLWH appear to parallel the experience in kidney transplant recipients.…”

Considerations For Use of Propensity Score Matching in Specific Patient Populations—Reply

“…In Reply We appreciate the Letter from Goei et al regarding our recent publication . They raise a number of questions and concerns related to the article that we would like to address.…”

Considerations for Use of Propensity Score Matching in Specific Patient Populations

“…To the Editor Zarinsefat and colleagues evaluated the long-term outcomes following kidney and liver transplants in recipients with HIV using a retrospective cohort study. Patients who are HIV-positive tend to have other comorbidities, including concomitant infections or AIDS-related conditions.…”

“…By matching HIV-positive and HIV-negative patients on pretransplant covariates, the authors aimed to produce 2 comparable groups at baseline to improve exchangeability of results. While the authors have done a commendable job, there are some suggestions for consideration.…”