Comparable Short-Term Survival in HIV-Positive and HIV-Negative Dual Organ Heart Transplant Recipients: A Call for Increased Access to Organ Donation for People Living with HIV.

Abstract

Access to organ transplantation for HIV-positive individuals is expanding, yet the outcomes of HIV-positive patients requiring multiorgan transplant are not well-defined. Adult individuals in the United Network for Organ Sharing (UNOS) registry who were HIV-positive and received HT between 2010 and 2023 were included. The primary outcome was patient survival. During the study period, 175 HIV-positive patients were transplanted. Twenty-six (14.8%) underwent dual organ transplantation (20 heart/kidney, 4 heart/lung, and 2 heart/liver) at 23 centers. Median age at the time of HT was 56 years (IQR 47-60), majority were male (n=18, 69%), and 46% identified as Black (n= 12). Dilated cardiomyopathy was the most common etiology of heart failure (n=13, 50%). All patients received organs from HIV-negative donors. The probability of surviving at least one year was 87.6% (95% CI 81.0- 92.0) for single-organ recipients and 82.9% for dual organ recipients (95% CI 60.0-93.4). There was no difference in overall survival between HIV-positive and HIV-negative matched controls among dual organ recipients (log-rank p-value = 0.8). Over the last decade, only a small number of HIV-positive individuals with end-stage heart failure have undergone dual organ transplantation with encouraging short-term outcomes.