A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action

Christine M Durand¹, Wanying Zhang², Diane M Brown¹, Sile Yu², Niraj Desai², Andrew D Redd^{1

3}, Serena M Bagnasco⁴, Fizza F Naqvi¹, Shanti Seaman¹, Brianna L Doby¹, Darin Ostrander¹, Mary Grace Bowring², Yolanda Eby⁴, Reinaldo E Fernandez¹, Rachel Friedman-Moraco^{5

6}, Nicole Turgeon^{6

7}, Peter Stock⁸, Peter Chin-Hong⁸, Shikha Mehta⁹, Valentina Stosor¹⁰, Catherine B Small¹¹, Gaurav Gupta¹², Sapna A Mehta¹³, Cameron R Wolfe¹⁴, Jennifer Husson¹⁵, Alexander Gilbert¹⁶, Matthew Cooper¹⁶, Oluwafisayo Adebiyi¹⁷, Avinash Agarwal¹⁸, Elmi Muller¹⁹, Thomas C Quinn^{1

3}, Jonah Odim²⁰, Shirish Huprikar²¹, Sander Florman²¹, Allan B Massie², Aaron A R Tobian⁴, Dorry L Segev²; HOPE in Action Investigators

Affiliations

¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
⁴ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Department of Medicine, Emory University, Atlanta, Georgia, USA.
⁶ Department of Surgery, Emory University, Atlanta, Georgia, USA.
⁷ Department of Surgery, Dell Medical School, University of Texas, Austin, Texas, USA.
⁸ Department of Medicine, University of California, San Francisco, California, USA.
⁹ Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁰ Department of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹¹ Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA.
¹² Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
¹³ NYU Langone Transplant Institute, New York University Grossman School of Medicine, New York, New York, USA.
¹⁴ Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
¹⁵ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹⁶ Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, District of Columbia, USA.
¹⁷ Department of Medicine, Indiana University Health Hospital, Indianapolis, Indiana, USA.
¹⁸ Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.
¹⁹ Department of Surgery, University of Cape Town, Cape Town, South Africa.
²⁰ Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
²¹ Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA.

PMID: 32701209
PMCID: PMC8073960
DOI: 10.1111/ajt.16205

Multicenter Study

A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action

Christine M Durand et al. Am J Transplant. 2021 May.

. 2021 May;21(5):1754-1764.

doi: 10.1111/ajt.16205. Epub 2020 Aug 8.

Authors

Affiliations

¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
⁴ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Department of Medicine, Emory University, Atlanta, Georgia, USA.
⁶ Department of Surgery, Emory University, Atlanta, Georgia, USA.
⁷ Department of Surgery, Dell Medical School, University of Texas, Austin, Texas, USA.
⁸ Department of Medicine, University of California, San Francisco, California, USA.
⁹ Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁰ Department of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹¹ Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA.
¹² Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
¹³ NYU Langone Transplant Institute, New York University Grossman School of Medicine, New York, New York, USA.
¹⁴ Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
¹⁵ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹⁶ Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, District of Columbia, USA.
¹⁷ Department of Medicine, Indiana University Health Hospital, Indianapolis, Indiana, USA.
¹⁸ Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.
¹⁹ Department of Surgery, University of Cape Town, Cape Town, South Africa.
²⁰ Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
²¹ Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA.

PMID: 32701209
PMCID: PMC8073960
DOI: 10.1111/ajt.16205

Abstract

HIV-positive donor to HIV-positive recipient (HIV D+/R+) transplantation is permitted in the United States under the HIV Organ Policy Equity Act. To explore safety and the risk attributable to an HIV+ donor, we performed a prospective multicenter pilot study comparing HIV D+/R+ vs HIV-negative donor to HIV+ recipient (HIV D-/R+) kidney transplantation (KT). From 3/2016 to 7/2019 at 14 centers, there were 75 HIV+ KTs: 25 D+ and 50 D- (22 recipients from D- with false positive HIV tests). Median follow-up was 1.7 years. There were no deaths nor differences in 1-year graft survival (91% D+ vs 92% D-, P = .9), 1-year mean estimated glomerular filtration rate (63 mL/min D+ vs 57 mL/min D-, P = .31), HIV breakthrough (4% D+ vs 6% D-, P > .99), infectious hospitalizations (28% vs 26%, P = .85), or opportunistic infections (16% vs 12%, P = .72). One-year rejection was higher for D+ recipients (50% vs 29%, HR: 1.83, 95% CI 0.84-3.95, P = .13) but did not reach statistical significance; rejection was lower with lymphocyte-depleting induction (21% vs 44%, HR: 0.33, 95% CI 0.21-0.87, P = .03). In this multicenter pilot study directly comparing HIV D+/R+ with HIV D-/R+ KT, overall transplant and HIV outcomes were excellent; a trend toward higher rejection with D+ raises concerns that merit further investigation.

Keywords: clinical research/practice; clinical trial; donors and donation: deceased; ethics and public policy; infection and infectious agents; infection and infectious agents - viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS); infectious disease; kidney transplantation/nephrology; law/legislation; rejection.

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Figures

**FIGURE 1**
Graft survival and rejection-free survival. Graft survival (A) and rejection-free patient survival (B) by donor HIV status, as well as rejection-free survival (C) by induction type (lymphocyte-depleting vs nonlymphocyte depleting). Shown as proportion of recipients over time from the day of transplant through 3 y posttransplant. The median observation times for graft survival were 1.2 y (interquartile range [IQR], 1.0–2.3) in the HIV D+ group and 1.8 y (IQR, 1.4–2.6) in the HIV D− group. The median observation times for rejection-free patient survival were 0.7 y (IQR, 0.2–1.4) in the HIV D+ group and 1.6 y (IQR, 0.7–2.3) in the HIV D− group. The median observation times for rejection-free survival were 1.4 y (IQR, 0.8–2.2) in the lymphocyte-depleting induction group and 1.0 y (IQR, 0.2–1.9) in the nonlymphocyte-depleting induction group

See this image and copyright information in PMC

Comment in

HIV-positive deceased donor-to-HIV-positive recipient kidney transplantation: The HOPE must go on.
Montero N, Moreso F, Cruzado JM. Montero N, et al. Am J Transplant. 2021 May;21(5):1683-1684. doi: 10.1111/ajt.16272. Epub 2020 Sep 9. Am J Transplant. 2021. PMID: 32810390 No abstract available.
Renal Transplantation.
Goldfarb DA. Goldfarb DA. J Urol. 2021 Sep;206(3):760-761. doi: 10.1097/JU.0000000000001917. Epub 2021 Jun 16. J Urol. 2021. PMID: 34130492 No abstract available.

References

1. Abraham AG, Althoff KN, Jing Y, et al. End-stage renal disease among HIV-infected adults in North America. Clin Infect Dis. 2015;60(6):941–949. - PMC - PubMed
1. Bickel M, Marben W, Betz C, et al. End-stage renal disease and dialysis in HIV-positive patients: observations from a long-term cohort study with a follow-up of 22 years. HIV Med. 2013;14(3):127–135. - PubMed
1. Gathogo E, Jose S, Jones R, et al. End-stage kidney disease and kidney transplantation in HIV-positive patients: an observational cohort study. J Acquir Immune Defic Syndr. 2014;67(2):177–180. - PubMed
1. Rasch MG, Helleberg M, Feldt-Rasmussen BO, et al. Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population. Nephrol Dial Transplant. 2014;29(6):1232–1238. - PubMed
1. Razzak Chaudhary S, Workeneh BT, Montez-Rath ME, Zolopa AR, Klotman PE, Winkelmayer WC. Trends in the outcomes of end-stage renal disease secondary to human immunodeficiency virus-associated nephropathy. Nephrol Dial Transplant. 2015;30(10):1734–1740. - PMC - PubMed

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A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action

Affiliations

A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action

Authors

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Abstract

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Medical