Liver transplantation (LT) from donors-with-HIV to recipients-with-HIV (HIV D+/R+) is permitted under the HOPE Act. There are only 3 international single case reports of HIV D+/R+ LT, each with limited follow-up. We performed a prospective multicenter pilot study comparing HIV D+/R+ to donors-without-HIV to recipients-with-HIV (HIV D-/R+) LT. We quantified patient survival, graft survival, rejection, serious adverse events (SAEs), HIV breakthrough, infections, and malignancies, using Cox and negative binomial regression with inverse probability of treatment weighting. Between March 2016-July 2019, there were 45 LTs (8 simultaneous liver-kidney) at 9 centers: 24 HIV D+/R+, 21 HIV D-/R+ (10 D- were false-positive). Median follow-up time was 23 months. Median recipient CD4 was 287 cells/µl with 100% on antiretroviral therapy; 56% were hepatitis C virus(HCV)-seropositive, 13% HCV-viremic. Weighted one-year survival was 83.3% vs. 100.0% in D+ vs D- groups (p=0.04). There were no differences in one-year graft survival (96.0% vs. 100.0%), rejection (10.8% vs. 18.2%), HIV breakthrough (8% vs 10%) or SAEs (all p>0.05). HIV D+/R+ had more opportunistic infections, infectious hospitalizations and cancer. In this multicenter pilot study of HIV D+/R+ LT, patient and graft survival were better than historical cohorts, however, a potential increase in infections and cancer merits further investigation.
This article is protected by copyright. All rights reserved.