HOPE in action: A prospective multicenter pilot study of liver transplantation from donors with HIV to recipients with HIV

• Published in: American journal of transplantation Vol. 22; no. 3; pp. 853 - 864
• Main Authors: Florman, Sander, Motter, Jennifer D., Brown, Diane, Ostrander, Darin, Liang, Tao, Werbel, William A., Cameron, Andrew, Ottmann, Shane, Hamilton, James P., Bowring, Mary G., Fernandez, Reinaldo E., Doby, Brianna, Labo, Nazzarena, Miley, Wendell, Price, Jennifer C., Stock, Peter, Kirchner, Varvara A., Elias, Nahel, Wolfe, Cameron, Quinn, Thomas C., Odim, Jonah, Morsheimer, Megan, Mehta, Sapna A., Rana, Meenakshi M., Huprikar, Shirish, Massie, Allan, Segev, Dorry L., Edwards, Carolyn, Ranganna, Karthik M, Pearson, Thomas, Mehta, Aneesh K, Lyon, G. Marshall, Huckaby, Jeryl, Elbein, Rivka, Ferry, Elizabeth, Adebiyi, Margaret, Adebiyi, Oluwafisayo, Kubal, Chandrahekhar, Ambinder, Richard, Barnaba, Brittany, Bollinger, Juli, Boyarsky, Brian, Desai, Niraj N, Johnstone, Jaylyn, Kirby, Charles, Klock, Ethan, Kusemiju, Oyinkansola, Schmidt, Haley, Seaman, Shanti, Thomas, Margret, Akhran, Aleya, Coakley, Margaret, Cooper, Matthew, Stucke, Alyssa, Castillo‐Lugo, Jose A, Townsend, Melba, Haydel, Brandy M., Dieter, Rebecca, Deterville, Cecilia, Klein, Elizabeth, Neumann, Henry, Weldon, Elaina P, Hand, Jonathan, Smith, Angela R, Blumberg, Emily A, Donaghy, Eileen, Dunn, Ty, Sawinski, Deirdre, Santos, Carlos A. Q, Mehta, Shikha, Mompoint‐Williams, Darnell, Gadzhyan, Janette, Aslam, Saima, Chao, Ada, Rogers, Rodney, Apewokin, Senu, Harrison, Kathleen, Kramer, Samantha, Wilkinson, Rachel, Benamu, Esther, Spaggiari, Mario, Bruno, Kelly, Jeffery, Alicia, Marrazzo, Ilise D, Morris, Michele I, Munoz, Carlos, Simkins, Jacques, Hughes Kramer, Kailey, Pakstis, Diana Lynn, Silveira, Fernanda, Baah, Whitney, Carlson, Emily, La Hoz, Ricardo M, Agarwal, Avinash, Baldecchi, Mary, Brigle, Nathaniel, Butkus‐Small, Catherine, Malinis, Maricar, Tomlin, Ricarda
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.03.2022
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral drugs; Antiretroviral therapy; Case reports; CD4 antigen; clinical research/practice; Donors; ethics and public policy; Follow-Up Studies; Graft rejection; Graft Survival; Graft-versus-host reaction; Hepatitis; Hepatitis C; HIV; HIV Infections - complications; Human immunodeficiency virus; Humans; infection and infectious agents ‐ viral: hepatitis C; infection and infectious agents ‐ viral: human herpesvirus 8 (HHV‐8); infection and infectious agents ‐ viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS); Infections; infectious disease; liver disease; liver disease: infectious; Liver diseases; Liver transplantation; Liver Transplantation - adverse effects; liver transplantation/hepatology; Liver transplants; Medical ethics; Patients; Pilot Projects; Prospective Studies; Tissue Donors; ethics and public policy; liver disease; infectious disease; clinical research/practice; infection and infectious agents - viral: hepatitis C; infection and infectious agents - viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS); infection and infectious agents - viral: human herpesvirus 8 (HHV-8); liver transplantation/hepatology; liver disease: infectious
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.16886

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. A multicenter study of HIV+ donor to HIV+ recipient liver transplantation under the HOPE Act shows that patient and graft survival were better than historical cohorts, but the possible increased incidence of infections and cancer merits further investigation.