Organ Transplantation in HIV Patients: Current Status and New Directions

Stosor, Valentina

doi:10.1007/s11908-013-0381-x

Cited by 8 publications

(4 citation statements)

References 93 publications

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“…Participants’ optimism and motivations were consistent with studies suggesting that kidney and liver transplantation confer a survival benefit and that transplant candidates living with HIV have lower access to transplantation than candidates without HIV. 3 , 4 , 6 , 7 , 22 Our findings are also consistent with early clinical data supporting the safety of HIV D + /R + transplantation. 14 , 21 , 23 - 25 However, at the time that most of these interviews were conducted (86%), results of experimental HIV D + /R + transplantation in the United States had not been published; the only published reports at the time were case reports or relatively small observational studies from South Africa.…”

Section: Discussionsupporting

confidence: 90%

“…1,2 While still experimental, HIV D + /R + transplantation has the potential to improve access to transplantation for transplant candidates living with HIV, who are at higher risk of end-stage organ failure and have decreased access to transplantation compared with those without HIV. [3][4][5][6][7][8] In addition, providing HIV D + /R + transplants may help attenuate the problem of organ shortages more generally. [9][10][11] Nevertheless, the implementation of HIV D + /R + transplantation presented involves ethical and psychosocial considerations.…”

Section: Introductionmentioning

confidence: 99%

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Patients’ Experiences With HIV-positive to HIV-positive Organ Transplantation

Rasmussen

Seaman

Johnson

et al. 2021

Transplantation Direct

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Background. HIV + donor (HIV D + ) to HIV + recipient (HIV R + ) transplantation involves ethical considerations related to safety, consent, stigma, and privacy, which could be better understood through studying patients’ actual experiences. Methods. We interviewed kidney and liver transplant recipients enrolled in clinical trials evaluating HIV D + /R + transplantation at 4 centers regarding their decision-making process, the informed consent process, and posttransplant experiences. Participants were interviewed at-transplant (≤3 wk after transplant), posttransplant (≥3 mo after transplant), or both time points. Interviews were analyzed thematically using constant comparison of inductive and deductive coding. Results. We conducted 35 interviews with 22 recipients (15 at-transplant; 20 posttransplant; 13 both time points; 85% participation). Participants accepted HIV D + organs because of perceived benefits and situational factors that increased their confidence in the trials and outweighed perceived clinical and social risks. Participants reported positive experiences with the consent process and the trial. Some described HIV-related stigma and emphasized the need for privacy; others believed HIV D + /R + transplantation could help combat such stigma. There were some indications of possible therapeutic misestimation (overestimation of benefits or underestimation of risks of a study). Some participants believed that HIV + transplant candidates were unable to receive HIV-noninfected donor organs. Conclusions. Despite overall positive experiences, some ethical concerns remain that should be mitigated going forward. For instance, based on our findings, targeted education for HIV + transplant candidates regarding available treatment options and for transplant teams regarding privacy and stigma concerns would be beneficial.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Patients’ Experiences With HIV-positive to HIV-positive Organ Transplantation

Rasmussen

Seaman

Johnson

et al. 2021

Transplantation Direct

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“…These enzymatic pathways are also involved in target of rapamycin inhibitor metabolism, a mainstay of immunosuppression in heart transplantation (Table 2). 30 Serious concerns have been raised about maintaining the appropriate level of immunosuppression after transplantation, with over immunosuppression potentially increasing the risk of opportunistic infections and AIDS-defining illnesses and inadequate immunosuppression increasing the likelihood of organ rejection. The issue of immunosuppression metabolism may be mitigated by the use of a newer class of antiretrovirals known as integrase strand transfer inhibitors, which are metabolized by an alternate UDP-glucuronosyltransferase 1-mediated pathway.…”

Section: Resultsmentioning

confidence: 99%

Cardiac Transplantation in HIV-Positive Patients: A Narrative Review

Wairimu

Ward

Liu

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Before the introduction of highly active antiretroviral therapy, patients infected with HIV experienced poor prognosis including high rates of opportunistic infections, rapid progression to AIDS, and significant mortality. Increased life expectancy after therapeutic improvements has led to an increase in other chronic diseases for these patients, including cardiovascular disease and, in particular, end-stage heart failure. Historically, HIV infection was deemed an absolute contraindication for transplantation. Since the development of highly active antiretroviral therapy, however, life expectancy for HIV-positive patients has significantly improved. In addition, there is a low incidence of opportunistic infections and the current antiretrovirals have an improved toxicity profile. Despite this, the current status of cardiac transplants in HIV-positive patients remains unclear. With this in mind, we conducted a narrative review on cardiac transplantation in patients with HIV.

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“…HIV‐infected (HIV+) transplant candidates have increased risk of waitlist mortality and decreased access to transplantation, compared to HIV‐uninfected (HIV−) candidates . Organs from HIV+ donors (HIV D+) can now be transplanted into HIV+ recipients (HIV R+) following the HIV Organ Policy Equity (HOPE) Act of 2013 .…”

Section: Introductionmentioning

confidence: 99%