HOPE in every breath and heartbeat: Understanding transplant eligibility, access barriers, and clinical outcomes in thoracic transplantation in persons with HIV

Abstract

Background

Persons with human immunodeficiency virus (PWH) are living longer, leading to increased end-organ disease from chronic illness. Organ transplantation improves survival in patients with end-organ disease yet remains a constrained resource due to limited access. We aimed to better understand barriers to transplantation for thoracic end-organ disease in PWH.

Methods

We performed a retrospective study of patients referred to our center for consideration of thoracic organ transplant and assessed the factors associated with transplant eligibility in candidates with human immunodeficiency virus (HIV). We also assessed clinical outcomes in PWH progressing to transplant.

Results

Over a 10-year period, 30 HIV-seropositive candidates and 10,905 HIV-seronegative candidates were referred to our center. Of candidates referred, 40% (12 of 30) of HIV-seropositive candidates were waitlisted compared to 20% (2,172 of 10,905) of HIV-seronegative candidates (p = 0.006). The median time from referral to waitlist activation in HIV-seropositive and HIV-seronegative candidates was similar (103 days vs 102 days, respectively; p = 0.92). Eight (27%) HIV-seropositive candidates underwent transplant compared to 1,962 (18%) HIV-seronegative candidates (p = 0.22). The median waitlist time in HIV-seropositive and HIV-seronegative candidates was similar (20 days vs 16 days, respectively; p = 0.98). Of the 8 HIV-seropositive transplant recipients, no recipient developed any HIV-associated complication, and 7 recipients (88%) survived beyond 1 year.

Conclusions

HIV-seropositive thoracic transplant candidates were more likely to be waitlisted compared to HIV-seronegative candidates. Progression to transplant and waitlist times were similar between candidates with and without HIV. Our study suggests that HIV alone was not a significant barrier to transplantation in PWH when referred and evaluated for thoracic organ transplantation.