A Prospective Multicenter Pilot Study of HIV-Positive Deceased Donor to HIV-Positive Recipient Kidney Transplantation: HOPE in Action.

HIV-positive donor to HIV-positive recipient (HIV D+/R+) transplantation is permitted in the United States under the HIV Organ Policy Equity Act. To explore safety and the risk attributable to an HIV+ donor, we performed a prospective multicenter pilot study comparing HIV D+/R+ versus HIV-negative donor to HIV+ recipient (HIV D-/R+) kidney transplantation (KT). From 3/2016- 7/2019 at 14 centers, there were 75 HIV+ KTs: 25 D+ and 50 D- (22 recipients from D- with false-positive HIV tests). Median follow-up was 1.7 years. There were no deaths nor differences in one-year graft survival (91% D+ vs 92% D-, p=0.9), one-year mean estimated glomerular filtration rate (63 ml/min D+ vs 57 ml/min D-, p=0.31), HIV breakthrough (4% D+ vs 6% D-, p>0.99), infectious hospitalizations (28% vs 26%, p=0.85), or opportunistic infections (16% vs 12%, p=0.72). One-year rejection was higher for D+ recipients (50% vs 29%, HR:1.83, 95%CI 0.84-3.95, p=0.13) but did not reach statistical significance; rejection was lower with lymphocyte-depleting induction (21% vs 44%, HR:. 0.33, 95%CI 0.21-0.87, p=0.03). In this multicenter pilot study directly comparing HIV D+/R+ with HIV D-/R+ KT, overall transplant and HIV outcomes were excellent; a trend towards higher rejection with D+ raises concerns that merit further investigation.