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Transplantation in HIV+ patients
A G Tzakis1, M H Cooper, J S Dummer
1Department of Surgery, University Health Center of Pittsburgh, PA 15213.
Transplantation
|February 1, 1990
Summary
Organ transplantation in human immunodeficiency virus (HIV)-positive patients showed varied survival rates, with pediatric recipients experiencing better outcomes than adults. Immunosuppression may accelerate acquired immunodeficiency syndrome (AIDS) progression.
Area of Science:
- Transplantation immunology
- Infectious diseases
- Organ transplantation outcomes
Background:
- Human immunodeficiency virus (HIV) infection poses unique challenges for organ transplantation.
- Historical practices before widespread donor/recipient screening led to HIV transmission via transplantation.
- The impact of immunosuppression on HIV progression in transplant recipients requires careful consideration.
Purpose of the Study:
- To evaluate the outcomes of organ transplantation in HIV-positive recipients.
- To compare survival rates across different organ types (liver, heart, kidney) and age groups (pediatric vs. adult).
- To assess the influence of transplantation and immunosuppression on the progression of acquired immunodeficiency syndrome (AIDS).
Main Methods:
- Retrospective analysis of 25 whole-organ recipients who were HIV carriers between 1981 and 1988.
- Data collection on infection status (pre- or perioperative), organ transplanted, patient age, and follow-up duration.
- Comparison of survival and causes of death, including AIDS-related mortality, with control groups.
Main Results:
- Overall survival rate was 13/25 recipients after a mean follow-up of 2.75 years.
- Pediatric recipients (10) had a 70% survival rate, with only one death due to AIDS.
- Adult recipients (15) had lower survival, with AIDS being the leading cause of death in 5 patients; transplantation appeared to shorten AIDS-free intervals.
Conclusions:
- Organ transplantation in HIV-positive individuals, particularly adults, carries significant risks, including accelerated AIDS progression.
- Pediatric recipients demonstrated better survival outcomes compared to adults.
- Systematic screening of donors, recipients, and blood products has significantly reduced the incidence of HIV transmission through transplantation since 1985.