Division of Infectious Diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Division of Nephrology, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Transpl Infect Dis. 2023 Aug;25(4):e14093. doi: 10.1111/tid.14093. Epub 2023 Jul 11.
The HIV Organ Policy Equity (HOPE) act afforded transplantation of organs from donors who have HIV. Herein we compared the long-term outcomes of recipients with HIV by donor HIV testing status.
Using the Scientific Registry of Transplant Recipients, we identified all primary adult kidney transplant recipients who were HIV-positive between 1/1/16-12/31/21. Recipients were grouped into three cohorts according to the donor HIV status based on antibody (Ab) and nucleic acid testing (NAT): Donor Ab-/NAT- (n = 810), Donor Ab+ /NAT- (n = 98), and Donor Ab+/NAT+ (n = 90). We compared recipient and death-censored graft survival (DCGS) by donor HIV testing status using Kaplan-Meier curves and Cox proportional hazards regression, censored at 3 years posttransplant. Secondary outcomes were delayed graft function (DGF) and the following 1-year outcomes: acute rejection, re-hospitalization, and serum creatinine.
In Kaplan-Meier analyses, patient survival and DCGS were similar by donor HIV status (log rank p = .667; log rank p = .388). DGF occurred more frequently in donors with HIV Ab-/NAT- testing compared with Ab+/NAT- or Ab+/NAT+ testing (38.0% vs. 28.6% vs. 26.7%, p = .028). Average dialysis time before transplant was twice as long for recipients who received organs from donors with Ab-/NAT- testing (p < .001). Acute rejection, re-hospitalization and serum creatinine at 12 months did not differ between the groups.
Patient and allograft survival for recipients living with HIV remains comparable irrespective of donor HIV testing status. Utilizing kidneys from deceased donors with HIV Ab+/NAT- or Ab+/NAT+ testing shortens dialysis time prior to transplant.
HIV 器官政策公平（HOPE）法案允许移植 HIV 感染者的器官。在此，我们比较了根据供体 HIV 检测状态，HIV 阳性受者的长期结果。
利用移植受者科学注册处，我们确定了所有在 2016 年 1 月 1 日至 2021 年 12 月 31 日期间 HIV 阳性的成年肾移植受者。受者根据抗体（Ab）和核酸检测（NAT）分为三组：供体 Ab-/NAT-（n=810）、供体 Ab+/NAT-（n=98）和供体 Ab+/NAT+（n=90）。我们通过 Kaplan-Meier 曲线和 Cox 比例风险回归比较了供体 HIV 检测状态对受者和死亡删失移植物存活率（DCGS）的影响，移植后 3 年截止。次要结果为延迟移植物功能（DGF）和 1 年以下的以下结果：急性排斥反应、再次住院和血清肌酐。
在 Kaplan-Meier 分析中，受者存活率和 DCGS 与供体 HIV 状态相似（对数秩检验 p=0.667；对数秩检验 p=0.388）。与 Ab+/NAT-或 Ab+/NAT+检测相比，HIV Ab-/NAT-检测的供体中 DGF 更常见（38.0%比 28.6%比 26.7%，p=0.028）。Ab-/NAT-检测供体的受者在移植前接受透析的时间是接受 Ab+/NAT-或 Ab+/NAT+检测供体的受者的两倍（p<0.001）。各组间 12 个月时的急性排斥反应、再次住院和血清肌酐无差异。
接受 HIV 感染者的肾移植受者的患者和移植物存活率仍然相似，与供体 HIV 检测状态无关。利用 HIV Ab+/NAT-或 Ab+/NAT+检测的已故供体的肾脏可以缩短移植前的透析时间。
