Patient survival in liver transplant recipients and graft survival in kidney transplant recipients was comparable among patients living with and without HIV, even 15 years later, researchers found in a retrospective study.

For liver transplant recipients, patient survival at 15 years among those living with HIV was 70% (95% CI 60.6-80.8%) compared to 75.7% (95% CI 71.8-79.8%) for those living without HIV (P=0.12), reported Arya Zarinsefat, MD, of the University of California San Francisco, and colleagues.

There was also no significant difference in graft survival at this timepoint among kidney transplant patients, at 75.0% for those with HIV (95% CI 65.3-86.2%) versus 57.0% (95% CI 47.8-68.0%) for those without HIV (P=0.77), the authors wrote in JAMA Surgery.

Moreover, on Cox proportional hazards regression adjusting for HIV status, a diagnosis of HIV was not tied to worse graft survival for kidney transplant recipients (HR 1.09, 95% CI 0.67-1.97) or to patient survival in liver transplant recipients (HR 1.36, 95% CI 0.83-2.24), they noted.

However, patient survival for kidney transplant recipients was significantly higher for those without HIV (79.6%, 95% CI 73.6-86.1%) compared to those living with HIV (53.6%, 95% CI 38.9-74.0%, P=0.03). “We believe this is likely related to long-term cardiovascular HIV/AIDS-related comorbidities, as studies have shown elevated risk of these complications in HIV-positive patients,” Zarinsefat and colleagues wrote.

“This study highlights that liver and kidney transplantation outcomes are excellent in patients with HIV and have improved with the advent of direct-acting antiviral agents for hepatitis C co-infected patients,” said Jonathan Schwartz, MD, of Montefiore Medical Center in New York City, who was not involved with the study. “Patients with controlled HIV do well, and should have ongoing access to life saving liver and kidney transplantation.”

Zarinsefat and colleagues evaluated data on 1,294 patients from the University of California San Francisco transplant recipient registry from 2000 to 2019. Main outcomes assessed patient and graft survival among kidney transplants, as well as liver transplant patient survival. Additional outcomes assessed acute rejection incidence associated with survival of kidney transplant grafts.

“We were unaware of any studies looking at the long-term outcomes of organ transplantation of HIV-positive recipients,” Zarinsefat told MedPage Today. “The only studies our team were aware of that looked at longer-term outcomes were database studies, and we hoped to look at greater than 10-year outcomes.”

There were 774 kidney transplant patients, including 119 with HIV, and 520 liver transplant patients, including 80 with HIV. Propensity matching was done on the basis of HIV status. Follow-up ended upon graft failure resulting in retransplantation or at death.

For kidney transplant recipients, mean age was about 52 years, 87-89% were men, and 52-65% were white. The most common etiologies were hypertension (20%), diabetic nephropathy (18%), focal glomerulosclerosis (8%), IgA nephropathy (5%), chronic glomerulosclerosis (3%), and polycystic kidney disease (3%).

Kidney transplant patients with a minimum of one acute rejection episode had a graft survival of 52.8% (95% CI 38.4-72.5%), as compared to 91.8% for those who did not have an acute rejection (P<0.001).

Christine Koval, MD, of the Cleveland Clinic in Ohio, who was also not involved with the study, commented that because “any episode of acute rejection was associated with an increased probability of allograft loss … such data should prompt kidney transplant programs to consider thymoglobulin induction as the rule for HIV-positive recipients.”

Mean age of liver transplant recipients was 53-54, about two-thirds were men, and 69-75% were white. About 58-60% of these patients had hepatitis C virus.

The analysis had several limitations, Zarinsefat and colleagues acknowledged, including its retrospective, single-center design and the resulting limitations of propensity score matching.

“We hope that this research will continue to show the long-term safety and appropriate use of organ transplantation in HIV-positive recipients,” Zarinsefat said. “Hopefully transplant centers throughout the country and world will continue to advance their own programs in transplanting HIV-infected patients.”