Photo Credit: gabrielhrech

The following is a summary of “Safety of kidney transplantation from donors with HIV,” published in the October 2024 issue of Infectious Disease by Durand et al. 

Kidney transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV emerged as a practice that began in 2016 under the U.S. congressional HIV Organ Policy Equity Act and was approved for research purposes only.  

Researchers conducted a retrospective study to assess safety and efficacy of bone marrow transplant in patients with sickle cell disease, including HIV-infected donors, without comparing them to non-HIV donors.  

They performed a study across 26 U.S. centers comparing kidney transplantation from deceased donors with HIV and those without HIV to recipients with HIV. The primary outcome was a safety event (a composite of death from any cause, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection), evaluated for noninferiority (margin for the upper bound of the 95% CI, 3.00). Secondary outcomes included overall survival, survival without graft loss, rejection, infection, cancer, and HIV superinfection.  

The results showed that 408 transplantation candidates were enrolled, with 198 receiving a kidney from a deceased donor; among them, 99 received a kidney from a donor with HIV and 99 from a donor without HIV. The adjusted hazard ratio for the composite primary outcome was 1.00 (95% CI, 0.73 to 1.38), indicating noninferiority. Secondary outcomes were similar regardless of donor HIV status: overall survival at 1 year was 94% vs 95% and at 3 years was 85% vs 87%; survival without graft loss at 1 year was 93% vs 90% and at 3 years was 84% vs 81%; and rejection at 1 year was 13% vs 21% and at 3 years was 21% vs 24%. The incidence of serious adverse events, infections, surgical or vascular complications, and cancer was comparable between groups. However, the incidence of HIV breakthrough infection was elevated in recipients of kidneys from donors with HIV (incidence rate ratio, 3.14; 95% CI, 1.02 to 9.63), with 1 potential HIV superinfection among the 58 recipients in this group with sequence data and no persistent failures of HIV treatment.  

They concluded kidney transplantation from donors with HIV was non-inferior to transplantation from donors without HIV. 

Source: nejm.org/doi/full/10.1056/NEJMoa2403733