Research Summary

Kidney Transplantation From HIV-Positive Donors to HIV-Positive Recipients Found to be Noninferior to Donors Without HIV

Jessica Ganga

A recent multi-center study shows that kidney transplantation from HIV-positive donors to HIV-positive recipients is noninferior to transplantation from HIV-negative donors in terms of safety and key clinical outcomes.

The observational study enrolled 408 kidney transplant candidates from 26 centers across the United States. Of the 408 candidates, 198 recipients underwent transplantation, with 99 receiving kidneys from deceased donors with HIV and 99 receiving kidneys from deceased donors without HIV. Researchers focused on a composite primary endpoint that included death, graft loss, serious adverse events, HIV breakthrough infection, persistent failure of HIV treatment, and opportunistic infection. Secondary outcomes assessed overall survival, graft survival, rates of rejection, and the incidence of infections or cancer.

The results showed that kidney transplantation from HIV-positive donors was noninferior to transplantation from HIV-negative donors in terms of the primary composite safety outcome. At 1 year, the overall survival was 94% in the HIV-positive donor group compared with 95% in the HIV-negative donor group, and survival without graft loss was 93% vs 90%, respectively.

Further, at 3 years, the overall survival was 85% in the HIV-positive donor group vs 87%, in the HIV-negative donor group with survival without graft loss being 84% vs 81%, respectively. Additionally, rejection rates were also comparable, with 13% of patients in the HIV-positive donor group experiencing rejection at 1 year compared with 21% in the HIV-negative donor group, and 21% vs 24% at 3 years.

The researchers observed that the incidence of “serious adverse events, infections, surgical or vascular complications, and cancer was similar in the groups.” The incidence rate ratio for HIV breakthrough infection was 3.14 (95% CI, 1.02 to 9.63). It was noted that there was one potential HIV superinfection among 58 recipients in this group with sequence data, and there were no persistent failures of HIV treatment.

 

Reference:

Durand CM, Massie A, Florman S, et al. Safety of kidney transplantation from donors with HIV. N Engl J Med. 2024;391:1390-1401. doi:10.1056/NEJMoa2403733