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Original Investigation
January 5, 2022

Long-term Outcomes Following Kidney and Liver Transplant in Recipients With HIV

Author Affiliations
  • 1Department of Surgery, University of California, San Francisco
  • 2School of Medicine, University of California, San Francisco
  • 3Department of Epidemiology and Biostatistics, University of California, San Francisco
JAMA Surg. Published online January 5, 2022. doi:10.1001/jamasurg.2021.6798
Key Points

Question  What are the long-term outcomes of patient and graft survival in kidney and liver transplant among HIV-positive patients?

Findings  In this cohort study looking at the long-term outcomes of kidney and liver transplant in 119 HIV-positive patients who were propensity matched to 655 HIV-negative patients, results showed similar long-term graft survival in kidney transplant and similar long-term patient survival in liver transplant. Additionally, HIV-positive kidney transplant recipients who had at least 1 episode of acute rejection had significantly reduced kidney graft survival.

Meaning  Kidney and liver transplant in HIV-positive patients may be an appropriate use of transplant resources, with comparable patient and graft survival.

Abstract

Importance  Kidney transplant (KT) and liver transplant (LT) in HIV-positive patients have become more widely adopted. Data looking at long-term outcomes of patient and graft survival are lacking.

Objective  To compare the long-term outcomes of KT and LT in HIV-positive recipients with matched HIV-negative recipients.

Design, Setting, and Participants  Retrospective, single-center, cohort, study using data from 2000 to 2019. Patients were observed until death, or graft failure requiring retransplant. All HIV-positive patients who underwent KT and/or LT between 2000 and 2019 were included. Propensity matching was performed to the corresponding HIV-negative cohort, which was obtained from the University of California, San Francisco’s transplant recipient registry. The data were analyzed from 2020 to 2021.

Exposures  HIV infection.

Main Outcomes and Measures  Patient and graft survival for KT and patient survival for LT. Incidence of acute rejection and its association with KT graft survival.

Results  For KT, 655 HIV-negative recipients (mean [SD] age, 52.3 [13.6] years; 450 [68.7%] were men) and 119 HIV-positive recipients (mean [SD] age, 51.7 [9.4] years; 86 [72.3%] were men) were included. Patient survival was 79.6% (95% CI, 73.6%-86.1%) and 53.6% (95% CI, 38.9%-74.0%) at 15 years posttransplant, respectively. Graft survival was 57.0% (95% CI, 47.8%-68.0%) and 75.0% (95% CI, 65.3%-86.2%) at 15 years posttransplant, respectively. Diagnosis of HIV was not associated with worse graft survival (hazard ratio, 1.09; 95% CI, 0.61-1.97; P = .77). For LT, 80 HIV-positive recipients (mean [SD] age, 52.6 [8.2] years; 53 [66.3%] were men) and 440 HIV-negative recipients (mean [SD] age, 54.6 [12.8] years; 291 [66.1%] were men) were included. Patient survival was 60.3% (95% CI, 49.0%-74.1%) and 65.3% (95% CI, 54.4%-78.2%) at 15 years posttransplant, respectively. Diagnosis of HIV was not a statistically significant predictor of patient survival (hazard ratio, 1.36; 95% CI, 0.83-2.24; P = .22). In KT, HIV-positive patients with at least 1 episode of acute rejection had a graft survival of 52.8% (95% CI, 38.4%-72.5%; P < .001) at 15 years posttransplant, compared with 91.8% in those without AR.

Conclusions and Relevance  In this single-center cohort study, KT and LT in HIV-positive patients had comparable long-term outcomes with those in matched HIV-negative patients. The high incidence of acute rejection was associated with reduced graft survival. The findings support providing transplant to HIV-positive patients, which may be an appropriate use of transplant resources and provides equitable access for HIV-positive patients.

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