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Longer-Term Outcomes of HIV-Positive–to–HIV-Positive Renal Transplantation

Year: 2019

Type: article

Abstract: To the Editor: The longer-term clinical outcomes of renal transplantation in human immunodeficiency virus (HIV)-positive patients who have received organs from HIV-positive donors, as well as the potential risks associated with donorderived HIV superinfection among such patients, are unknown. 1,2We followed all HIV-positive patients in South Africa who received kidney transplants from HIV-positive donors (total of 51 recipients).The study was approved by the University of Cape Town Human Research Ethics committee, and all the patients provided written informed consent.Samples of plasma and peripheral-blood mononuclear cells (PBMCs) were collected from 15 donors and 26 recipients who were involved in transplantations performed after 2011.The samples were tested for the presence of antiretroviral drugs, and a deep-sequencing assay was used to test the samples for HIV drug-resistant mutations, evidence of viral inoculum from the donor, and sustained donor-derived HIV superinfection. 3,4ll the recipients had viral suppression at the time of transplantation, and most continued to receive their pretransplantation antiretroviral therapy (ART) regimen.(See Supplementary Appendix 1, available with the full text of this letter at NEJM.org, for details of the methods and Table S1 for characteristics of the donors and recipients at baseline.)In an analysis in which the data from patients who died with a functioning graft were censored at the time of death, graft survival was 96% (95% confidence interval [CI], 85 to 99) at 1 year, 93% (95% CI, 79 to 98) at 3 years, and 79% (95% CI, 58 to 91) at 5 years (Fig. 1A).A total of 8 patients (16%) died after transplantation from non-graft-related causes.Patient survival was 87% (95% CI, 74 to 94) at 1 year, 87% (95% CI, 74 to 94)

Source: New England Journal of Medicine

DOI: 10.1056/nejmc1903013