Heart or lung transplant outcomes in HIV-infected recipients

doi:10.1016/j.healun.2019.09.011

The Journal of Heart and Lung Transplantation

Volume 38, Issue 12, December 2019, Pages 1296-1305

https://doi.org/10.1016/j.healun.2019.09.011 Get rights and content

BACKGROUND

Limited published data exist on outcomes related to heart and/or lung transplantation in human immunodeficiency virus (HIV)-infected individuals.

METHODS

We conducted a multicenter retrospective study of heart and lung transplantation in HIV-infected patients and describe key transplant- and HIV-related outcomes.

RESULTS

We identified 29 HIV-infected thoracic transplant recipients (21 heart, 7 lung, and 1 heart and/or lung) across 14 transplant centers from 2000 through 2016. Compared with an International Society for Heart and Lung Transplantation registry cohort, we demonstrated similar 1-, 3-, and 5-year patient and allograft survivals for each organ type with a median follow up of 1,064 (range, 184–3,745) days for heart and 1,540 (range, 116–3,206) days for lung recipients. At 1 year, significant rejection rates were high (62%) for heart transplant recipients (HTRs). Risk factors for rejection were inconclusive, likely because of small numbers, but may be related to cautious early immunosuppression and infrequent use of induction therapy. Pulmonary bacterial infections were high (86%) for lung transplant recipients (LTRs). Median CD4 counts changed from baseline to 1 year from 399 to 411 cells/µl for HTRs and 638 to 280 cells/µl for LTRs. Acquired immunodeficiency syndrome–related events, including infections and malignancies, were rare. Rates of severe renal dysfunction suggest a need to modify nephrotoxic anti-retrovirals and/or immunosuppressants.

CONCLUSIONS

HIV-infected HTRs and LTRs have similar survival rates to their HIV-uninfected counterparts. Although optimal immunosuppression is not defined, it should be at least as aggressive as that for HIV-uninfected recipients. Such data may help pave the way for the use of hearts and lungs from HIV-infected donors in HIV-infected recipients through HIV Organ Policy Equity Act protocols.

Section snippets

Methods

We conducted a retrospective multicenter study involving HIV-infected adults that underwent heart, lung, or heart and/or lung transplant with at least 1 year of follow up. Participating transplant centers were identified through the American Society of Transplantation and International Society for Heart and Lung Transplantation (ISHLT) memberships with approval of the society's executive committees. Institutional review board approval was granted at participating sites. Data were generated as

Results

Patient characteristics are listed in Table 1. There were 21 heart, 7 lung, and 1 heart and/or lung transplants reported in 29 recipients from 14 sites in the US and Europe. Five HTRs were previously reported, and all US cases likely were published recently from SRTR data.¹⁴^,¹⁵ Median follow up was 1,064 days (range, 184–3,745) for HTRs and 1,540 days (range, 116–3,206) for LTRs. Median age was 48 years (range, 27–58) for HTRs and 57 years (range, 37–70) for LTRs. Median time on the wait list

Discussion

These results demonstrate very good outcomes for heart and/or lung transplantation in HIV-infected recipients, validating and expanding upon previous reports in the field. This includes 2 recent publications of similar groups of HIV-infected HTRs from the SRTR database, one reporting 41 HTRs transplanted between 2004 and 2017 and the other reporting 35 of these same HTRs transplanted between 2004 and 2016.¹⁴^,¹⁵ Of the patients in this study, 19 HTRs were part of these registries. Rates of

Disclosure statement

P.G. reports personal fees from Gliead, Biotest, Merck, Sharp & Dohme, and Shire. The authors report no other financial conflicts. We thank our contributors including Katie Stankowski, PharmD, Cameron Wolfe, MD, PhD, Blair Weikart, MD, Cynthia Gay, MD, Sean Pinney, MD, Alessandro Palleschi, MD, Camille Kotton, MD, David Epstein, MD, and Ryan Levine.

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Citation Excerpt :
Reports of HT in patients with HIV infection are limited. One multicenter retrospective study reported outcomes of 21 HTs and one heart-lung transplant from 2000 through 2016.64 Although rates of moderate to severe rejection at 1 year were high (62%), rates of survival were similar at 1, 3, and 5 years compared with an ISHLT registry cohort.
Although the burden of end-stage heart failure continues to increase, the number of available organs for heart transplantation (HT) remains inadequate. The HT community has been challenged to find ways to expand the number of donor hearts available. Recent advances include use of hearts from donors infected with hepatitis C virus as well as other previously underutilized donors, including those with left ventricular dysfunction, of older age, and with a history of cocaine use. Concurrently, emerging trends in HT surgery include donation after circulatory death, ex vivo normothermic heart perfusion, and controlled hypothermic preservation, which may enable procurement of organs from farther distances and prevent early allograft dysfunction. Contemporary HT recipients have also evolved in light of the 2018 revision to the U.S. heart allocation policy. This focus seminar discusses recent trends in donor and recipient phenotypes and management strategies for successful HT, as well as evolving areas and future directions.

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Heart or lung transplant outcomes in HIV-infected recipients

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

Section snippets

Methods

Results

Discussion

Disclosure statement

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