Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar;10(1):107-120.
doi: 10.1007/s40506-018-0144-1. Epub 2018 Mar 5.

Solid Organ Transplantation for HIV-Infected Individuals

Ashton A Shaffer  1   2 , Christine M Durand  3   4
Affiliations

Solid Organ Transplantation for HIV-Infected Individuals

Ashton A Shaffer et al. Curr Treat Options Infect Dis. 2018 Mar.

Abstract

Purpose of review: The prevalence of end-stage organ disease is increasing among HIV-infected (HIV+) individuals. Individuals with well-controlled HIV on antiretroviral therapy (ART), without active opportunistic infections or cancer, and with specified minimum CD4 cell counts are appropriate transplant candidates. Infectious disease clinicians can improve access to transplantation for these patients and optimize management pre- and post-transplant.

Recent findings: Clinical trials and registry-based studies demonstrate excellent outcomes for select HIV+ kidney and liver transplant recipients with similar patient and graft survival as HIV-uninfected patients. Elevated allograft rejection rates have been observed in HIV+ individuals; this may be related to a dysregulated immune system or drug interactions. Lymphocyte-depleting immunosuppression has been associated with lower rejection rates without increased infections using national registry data. Hepatitis C virus (HCV) coinfection has been associated with worse outcomes, however improvements are expected with direct-acting antivirals.

Summary: Solid organ transplantation should be considered for HIV+ individuals with end-stage organ disease. Infectious disease clinicians can optimize ART to avoid pharmacoenhancers, which interact with immunosuppression. The timing of HCV treatment (pre- or post-transplant) should be discussed with the transplant team. Finally, organs from HIV+ donors can now be considered for HIV+ transplant candidates, within research protocols.

Keywords: HIV infection; end-stage liver disease; end-stage renal disease; immunosuppression; kidney transplant; liver transplant; solid organ transplantation.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Ashton A. Shaffer declares that she has no conflict of interest. Christine M. Durand has received research grants from Bristol Meyers Squibb, Gilead Sciences, Merck Pharmaceuticals, and Viiv Healthcare, and has served as a scientific advisor for Bristol Meyers Squibb, Gilead Sciences, and Merck Pharmaceuticals.

Figures

Figure 1
Figure 1
Annual number of HIV+ recipients (y-axis, left) has grown since 2000 for kidney transplants (A), liver transplants (B), and heart transplants (C), but remained rare for lung transplants (D). The total number of annual transplants per organ is shown for reference as a dashed line (y-axis, right).
See this image and copyright information in PMC

References

    1. Bradley H, Hall HI, Wolitski RJ, Van Handel MM, Stone AE, LaFlam M, Skarbinski J, Higa DH, Prejean J, Frazier EL, Patel R, et al. Vital signs: Hiv diagnosis, care, and treatment among persons living with hiv–united states, 2011. MMWR Morb Mortal Wkly Rep. 2014;63(47):1113–1117. - PMC - PubMed
    1. Prevention. CfDCa. Hiv surveillance report, 2014. 26
    1. Palella FJ, Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. Hiv outpatient study investigators. N Engl J Med. 1998;338(13):853–860. - PubMed
    1. Singh S, Bradley H, Hu X, Skarbinski J, Hall HI, Lansky A, Centers for Disease C, Prevention Men living with diagnosed hiv who have sex with men: Progress along the continuum of hiv care–united states, 2010. MMWR Morb Mortal Wkly Rep. 2014;63(38):829–833. - PMC - PubMed
    1. Losina E, Freedberg KA. Life expectancy in hiv. BMJ. 2011;343(d6015) - PubMed

LinkOut - more resources