Research shows similar results between those with HIV and those without, although 15 years post-kidney transplant, outcomes were worse for people with HIV.
Many U.S. transplant centers have HIV-infected patients as recipients, although, historically, there was some hesitancy about transplanting organs into such patients. And while the numbers are going up for liver transplantation for people with HIV patients, there is still some hesitancy about transplantation, particularly for people with HIV who are also infected with hepatitis C.
A new study titled “Long-term Outcomes Following Kidney and Liver Transplant in Recipients With HIV,” published early last month in the JAMA Surgery, may put some of those concerns to rest.
“Our motivation for the paper was due to the lack of any studies looking at long-term (more than 10 years) outcomes in patients with HIV undergoing liver and kidney transplantation,” lead author Arya Zarinsefat, M.D., chief resident, general surgery at the University of California, San Francisco, (UCSF) said in email exchange with Managed Healthcare Executive®. “While other studies have shown excellent outcomes in the short-term, looking at long-term outcomes was very important to us.”
Zarinsefat explained that given the significant immunosuppression required for organ transplantation, transplant centers were originally quite hesitant to transplant HIV-positive patients, given their already immunosuppressed baseline. To ensure patient safety and also an appropriate use of a limited supply of organs, it was important for centers to see research showing that people with HIV could experience lasting benefit from an organ transplant and, in the case of this study, of kidney and liver transplants in particular.
The study included 119 HIV-positive transplants patients at UCSF who were matched with 655 HIV-negative patients,
The findings from reported by Zarinsefat and his colleagues showed some differences between those with HIV and those without when it came to kidney transplants. The graft survival was equivalent in HIV- positive and the HIV-negative patients. For kidney transplant recipients, overall survival was similar for the first five years after the transplant, and very similar up to 10 years post-transplant.
“Overall survival began to diverge after 10 years post-transplant, and at 15 years post-transplant overall survival was worse for HIV- positive patients,” Zarinsefat said in the email to MHE. “We believe that this difference in overall survival at 15 years post-transplant is likely due to the multiple underlying comorbidities for HIV-negative positive patients, particularly cardiovascular complications which are known to be increased in patients with HIV.”
For liver transplant, their findings showedno significant difference in overall survival at 15 years post-transplant for people with HIV compared with people without it.
Additionally, one of the key concerns for transplanting HIV- positive patients is in those patients with HIV/hepatitis co-infection, noted Zarinsefat.
“We broke down our center’s data for transplantation (data)pre- and post-2014 in HIV/hep C coinfected patients, the year in which our institution had begun using hepatitis C antivirals to treat hepatitis C.
“What we noted,” he continued, “was that there was a significant difference in overall survival favoring HIV/hepatitis C coinfected patient post-2014, with survival of these patients being nearly identical to patients without hepatitis C and just HIV.”
The researchers hope their findings will lead to future studies at other institutions, and additional acceptance for transplantation of HIV-infected recipients.
“Given our findings over the long-term, we believe this study will further contribute to the existing body of literature that transplantation of HIV- positive patients is both safe, effective, and an appropriate utilization of transplant resources,” Zarinsefat said. “We hope that other centers will also publish their long-term outcomes to continue to build on the body of literature that is currently available.”