Division of Transplantation, Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.
University of Virginia, Charlottesville, Virginia, USA.
Transpl Infect Dis. 2022 Dec;24(6):e13916. doi: 10.1111/tid.13916. Epub 2022 Aug 12.
Improved survival among people with human immunodeficiency virus (HIV) (PWH) has led to increased organ failure, necessitating transplantation. In 2013, the HIV Organ Policy Equity (HOPE) Act was passed, allowing PWH to donate organs to other PWH. No study has assessed organ quality and quantity among a national pool of PWH.
CFAR Network of Integrated Clinical Systems (CNICS), a multicenter study capturing data on PWH, was used to identify 6504 deaths from 1999 to 2018. Exclusions included cause of death, chronic kidney disease, fibrosis-4 score ≥ 3.25, and opportunistic infection at the time of death. Donor quality was defined by HIV viremia and the kidney donor profile index (KDPI). The CDC Wonder database, which contains national death data, permitted the estimation of deaths among PWH nationally from 1999 to 2018. Assuming CNICS was representative of PWH nationally, percentages of potential donors were applied to the CDC Wonder cohort.
Within CNICS, there were 3241 (65.9%) potential kidney donors and 3536 (71.9%) potential liver donors from 1999 to 2018. Based on viremia and KDPI, 821 were lower-risk kidney donors (16.7%) and 1206 (24.5%) were lower-risk liver donors. Within CDC Wonder, we identified 12 048 potential donors from 1999 to 2018. Extrapolating from CNICS to the national cohort suggested 396 kidney donors (792 kidneys) and 433 liver donors annually, with 100 kidney donors (200 kidneys) and 147 livers being lower-risk.
A substantial number of PWH meet donation criteria, a valuable source of organs for PWH in need of transplants. Our estimates suggest there may be more available organs from PWH than current transplant numbers indicate.
人类免疫缺陷病毒（HIV）感染者（PWH）的生存率提高导致器官衰竭增加，需要进行移植。2013 年，HIV 器官政策公平（HOPE）法案通过，允许 PWH 将器官捐献给其他 PWH。尚无研究评估全国范围内 PWH 器官的质量和数量。
CFAR 网络综合临床系统（CNICS）是一项多中心研究，用于收集 1999 年至 2018 年期间 PWH 的死亡数据。排除标准包括死因、慢性肾脏病、纤维化-4 评分≥3.25 以及死亡时的机会性感染。供体质量由 HIV 病毒血症和肾脏供体概况指数（KDPI）定义。国家死亡数据包含在 CDC 奇迹数据库中，允许从 1999 年至 2018 年估计全国范围内 PWH 的死亡人数。假设 CNICS 代表全国 PWH 的代表性，将潜在供体的百分比应用于 CDC 奇迹队列。
在 CNICS 中，1999 年至 2018 年期间有 3241 例（65.9%）潜在的肾脏供体和 3536 例（71.9%）潜在的肝脏供体。根据病毒血症和 KDPI，821 例为低风险肾脏供体（16.7%），1206 例（24.5%）为低风险肝脏供体。在 CDC 奇迹中，我们在 1999 年至 2018 年期间确定了 12048 例潜在供体。从 CNICS 推断到全国队列，每年有 396 例肾脏供体（792 个肾脏）和 433 例肝脏供体，其中 100 例肾脏供体（200 个肾脏）和 147 例肝脏供体为低风险。
相当数量的 PWH 符合捐赠标准，这是需要移植的 PWH 器官的宝贵来源。我们的估计表明，可能有比当前移植数量显示的更多的 PWH 可用器官。
