TY - JOUR
T1 - HOPE in action
T2 - A prospective multicenter pilot study of liver transplantation from donors with HIV to recipients with HIV
AU - the HOPE in Action Investigators
AU - Durand, Christine M.
AU - Florman, Sander
AU - Motter, Jennifer D.
AU - Brown, Diane
AU - Ostrander, Darin
AU - Yu, Sile
AU - Liang, Tao
AU - Werbel, William A.
AU - Cameron, Andrew
AU - Ottmann, Shane
AU - Hamilton, James P.
AU - Redd, Andrew D.
AU - Bowring, Mary G.
AU - Eby, Yolanda
AU - Fernandez, Reinaldo E.
AU - Doby, Brianna
AU - Labo, Nazzarena
AU - Whitby, Denise
AU - Miley, Wendell
AU - Friedman-Moraco, Rachel
AU - Turgeon, Nicole
AU - Price, Jennifer C.
AU - Chin-Hong, Peter
AU - Stock, Peter
AU - Stosor, Valentina
AU - Kirchner, Varvara A
AU - Pruett, Timothy
AU - Wojciechowski, David
AU - Elias, Nahel
AU - Wolfe, Cameron
AU - Quinn, Thomas C.
AU - Odim, Jonah
AU - Morsheimer, Megan
AU - Mehta, Sapna A.
AU - Rana, Meenakshi M.
AU - Huprikar, Shirish
AU - Massie, Allan
AU - Tobian, Aaron A.R.
AU - Segev, Dorry L.
AU - Pereira, Marcus
AU - Piquant, Dominique
AU - Edwards, Carolyn
AU - Ranganna, Karthik M.
AU - Link, Katherine
AU - Pearson, Thomas
AU - Mehta, Aneesh K.
AU - Lyon, G. Marshall
AU - Kitchens, William
AU - Huckaby, Jeryl
AU - La Hoz, Ricardo M.
N1 - Publisher Copyright:
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - clinical research/practice
KW - ethics and public policy
KW - infection and infectious agents - viral: hepatitis C
KW - infection and infectious agents - viral: human herpesvirus 8 (HHV-8)
KW - infection and infectious agents - viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
KW - infectious disease
KW - liver disease
KW - liver disease: infectious
KW - liver transplantation/hepatology
UR - http://www.scopus.com/inward/record.url?scp=85120604398&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85120604398&partnerID=8YFLogxK
U2 - 10.1111/ajt.16886
DO - 10.1111/ajt.16886
M3 - Article
C2 - 34741800
AN - SCOPUS:85120604398
SN - 1600-6135
VL - 22
SP - 853
EP - 864
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 3
ER -