Comparable short-term survival in dual organ heart transplant recipients with and without HIV: A call for increased access to organ donation for people living with HIV

Abstract

Access to organ transplantation for individuals with HIV is expanding, yet the outcomes of patients with HIV requiring multiorgan transplants are not well-defined. Adult individuals with HIV in the United Network for Organ Sharing registry and who received heart transplantation between 2010 and 2023 were included. The primary outcome was patient survival. During the study period, 175 patients with HIV 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 heart transplantation was 56 years (interquartile range 47-60); the 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 donors without HIV. The probability of surviving at least 1 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 matched controls with HIV and matched controls without HIV among dual organ recipients (log-rank P value = .8). Over the last decade, only a small number of individuals with HIV with end-stage heart failure have undergone dual organ transplantation with encouraging short-term outcomes.