Recipient and kidney graft outcomes of deceased donors with human immunodeficiency virus in the United States

Background: The HIV Organ Policy Equity (HOPE) act afforded transplantation of organs from donors who have HIV. Herein we compared the long-term outcomes of recipients with HIV by donor HIV testing status. Methods: Using the Scientific Registry of Transplant Recipients, we identified all primary adult kidney transplant recipients who were HIV-positive between 1/1/16-12/31/21. Recipients were grouped into three cohorts according to the donor HIV status based on antibody (Ab) and nucleic acid testing (NAT): Donor Ab−/NAT− (n = 810), Donor Ab+ /NAT− (n = 98), and Donor Ab+/NAT+ (n = 90). We compared recipient and death-censored graft survival (DCGS) by donor HIV testing status using Kaplan–Meier curves and Cox proportional hazards regression, censored at 3 years posttransplant. Secondary outcomes were delayed graft function (DGF) and the following 1-year outcomes: acute rejection, re-hospitalization, and serum creatinine. Results: In Kaplan–Meier analyses, patient survival and DCGS were similar by donor HIV status (log rank p =.667; log rank p =.388). DGF occurred more frequently in donors with HIV Ab−/NAT− testing compared with Ab+/NAT− or Ab+/NAT+ testing (38.0% vs. 28.6% vs. 26.7%, p =.028). Average dialysis time before transplant was twice as long for recipients who received organs from donors with Ab−/NAT− testing (p <.001). Acute rejection, re-hospitalization and serum creatinine at 12 months did not differ between the groups. Conclusions: Patient and allograft survival for recipients living with HIV remains comparable irrespective of donor HIV testing status. Utilizing kidneys from deceased donors with HIV Ab+/NAT− or Ab+/NAT+ testing shortens dialysis time prior to transplant. (Figure presented.).