Safety of Kidney Transplantation from Donors with HIV

This multicenter, observational, noninferiority study evaluated the safety of kidney transplantation from deceased donors with HIV to recipients with HIV, comparing outcomes with transplants from donors without HIV. Conducted at 26 U.S. centers under the HOPE Act framework, 198 recipients were analyzed (99 per group). The primary composite safety outcome included death, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection. The adjusted hazard ratio was 1.00 (95% CI, 0.73–1.38), meeting noninferiority criteria. Secondary outcomes including overall survival, graft survival, rejection, infection, and cancer were similar across groups. HIV breakthrough infection was more frequent in the HIV-donor group (IRR, 3.14; 95% CI, 1.02–9.63), mostly due to nonadherence, with no persistent treatment failure. One potential HIV superinfection was identified without clinical consequence. The findings support expanding HIV-to-HIV kidney transplantation from research to clinical practice.

This multicenter, observational, noninferiority study evaluated the safety of kidney transplantation from deceased donors with HIV to recipients with HIV, comparing outcomes with transplants from donors without HIV. Conducted at 26 U.S. centers under the HOPE Act framework, 198 recipients were analyzed (99 per group). The primary composite safety outcome included death, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection. The adjusted hazard ratio was 1.00 (95% CI, 0.73–1.38), meeting noninferiority criteria. Secondary outcomes including overall survival, graft survival, rejection, infection, and cancer were similar across groups. HIV breakthrough infection was more frequent in the HIV-donor group (IRR, 3.14; 95% CI, 1.02–9.63), mostly due to nonadherence, with no persistent treatment failure. One potential HIV superinfection was identified without clinical consequence. The findings support expanding HIV-to-HIV kidney transplantation from research to clinical practice.