Kidney transplantation from deceased donors with HIV is non-inferior to that from donors without HIV among recipients with HIV, according to a study published in the New England Journal of Medicine. The multicenter, observational study suggests a potential avenue for expanding the donor pool for HIV-positive individuals in need of kidney transplants.
The study, led by Christine M. Durand, M.D., from Johns Hopkins University School of Medicine, compared outcomes of kidney transplants from deceased donors with and without HIV to recipients with HIV. The primary outcome was a composite safety event, including death, graft loss, serious adverse events, HIV breakthrough, treatment failure, or opportunistic infection, assessed for noninferiority.
Study Design and Results
The researchers enrolled 408 transplantation candidates, with 198 receiving a kidney from a deceased donor. Of these, 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 percent confidence interval, 0.73 to 1.38), demonstrating noninferiority. Overall survival at one and three years, survival without graft loss at one and three years, and rejection at one and three years were similar irrespective of the donor's HIV status.
The incidence of serious adverse events, infections, surgical or vascular complications, and cancer were also similar between the groups. However, recipients of kidneys from donors with HIV had a higher incidence of HIV breakthrough infection (incidence rate ratio, 3.14).
Implications and Future Directions
"This multicenter, observational study showed that kidney transplantation from donors with HIV to recipients with HIV is noninferior to kidney transplantation from donors without HIV to recipients with HIV," the authors wrote. The findings suggest that utilizing HIV-positive donors could help alleviate the shortage of available kidneys for transplantation, particularly for HIV-positive recipients. Further research is warranted to optimize immunosuppression protocols and minimize the risk of HIV breakthrough infection in this population.
