HIV and Solid Organ Transplantation: Where Are we Now

Abstract

Purpose of review: We review the international evolution of HIV and solid organ transplantation over 30 years. We emphasise recent developments in solid organ transplantation from HIV-infected to HIV-uninfected individuals, and their implications.

Recent findings: In 2017, Johannesburg, South Africa, a life-saving partial liver transplant from an HIV-infected mother to her HIV-uninfected child was performed. This procedure laid the foundation not only for consideration of HIV-infected individuals as living donors, but also for the possibility that HIV-uninfected individuals could receive organs from HIV-infected donors. Recent advances in this field are inclusion of HIV-infected individuals as living organ donors and the possibility of offering HIV-uninfected individuals organs from HIV-infected donors who are well-controlled on combination antiretroviral therapy (cART). The large number of HIV-infected individuals on cART is an unutilised source of otherwise eligible living organ donors. HIV-positive-to-HIV-negative organ transplantation has become a reality, providing possible new therapeutic options to address extreme organ shortages.

Keywords: Antiretroviral therapy; HIV; HIV-positive-to-HIV-negative; Living donor; Solid organ transplantation; South Africa.

Fig. 1

Timeline of key developments in the field of solid organ transplantation in the context of HIV infection. SOT, solid organ transplant; USA, United States of America; SA, South Africa; D, donor; R, recipient, −, HIV-negative; +, HIV-positive