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- Title
Long-term Outcomes Following Kidney and Liver Transplant in Recipients With HIV.
- Authors
Zarinsefat, Arya; Gulati, Arushi; Shui, Amy; Braun, Hillary; Rogers, Rodney; Hirose, Ryutaro; Ascher, Nancy; Stock, Peter
- Abstract
<bold>Importance: </bold>Kidney transplant (KT) and liver transplant (LT) in HIV-positive patients have become more widely adopted. Data looking at long-term outcomes of patient and graft survival are lacking.<bold>Objective: </bold>To compare the long-term outcomes of KT and LT in HIV-positive recipients with matched HIV-negative recipients.<bold>Design, Setting, and Participants: </bold>Retrospective, single-center, cohort, study using data from 2000 to 2019. Patients were observed until death, or graft failure requiring retransplant. All HIV-positive patients who underwent KT and/or LT between 2000 and 2019 were included. Propensity matching was performed to the corresponding HIV-negative cohort, which was obtained from the University of California, San Francisco's transplant recipient registry. The data were analyzed from 2020 to 2021.<bold>Exposures: </bold>HIV infection.<bold>Main Outcomes and Measures: </bold>Patient and graft survival for KT and patient survival for LT. Incidence of acute rejection and its association with KT graft survival.<bold>Results: </bold>For KT, 655 HIV-negative recipients (mean [SD] age, 52.3 [13.6] years; 450 [68.7%] were men) and 119 HIV-positive recipients (mean [SD] age, 51.7 [9.4] years; 86 [72.3%] were men) were included. Patient survival was 79.6% (95% CI, 73.6%-86.1%) and 53.6% (95% CI, 38.9%-74.0%) at 15 years posttransplant, respectively. Graft survival was 57.0% (95% CI, 47.8%-68.0%) and 75.0% (95% CI, 65.3%-86.2%) at 15 years posttransplant, respectively. Diagnosis of HIV was not associated with worse graft survival (hazard ratio, 1.09; 95% CI, 0.61-1.97; P = .77). For LT, 80 HIV-positive recipients (mean [SD] age, 52.6 [8.2] years; 53 [66.3%] were men) and 440 HIV-negative recipients (mean [SD] age, 54.6 [12.8] years; 291 [66.1%] were men) were included. Patient survival was 75.7% (95% CI, 71.8%-79.8%) for HIV-negative LT recipients and 70.0% (95% CI, 60.6%-80.8%) for HIV-positive LT recipients at 15 years posttransplant. Diagnosis of HIV was not a statistically significant predictor of patient survival (hazard ratio, 1.36; 95% CI, 0.83-2.24; P = .22). In KT, HIV-positive patients with at least 1 episode of acute rejection had a graft survival of 52.8% (95% CI, 38.4%-72.5%; P < .001) at 15 years posttransplant, compared with 91.8% in those without AR.<bold>Conclusions and Relevance: </bold>In this single-center cohort study, KT and LT in HIV-positive patients had comparable long-term outcomes with those in matched HIV-negative patients. The high incidence of acute rejection was associated with reduced graft survival. The findings support providing transplant to HIV-positive patients, which may be an appropriate use of transplant resources and provides equitable access for HIV-positive patients.
- Subjects
HIV infection complications; GRAFT rejection; KIDNEYS; GRAFT survival; RETROSPECTIVE studies; LIVER transplantation; LONGITUDINAL method
- Publication
JAMA Surgery, 2022, Vol 157, Issue 3, p240
- ISSN
2168-6254
- Publication type
journal article
- DOI
10.1001/jamasurg.2021.6798