Outcomes of heart transplantation in patients with human immunodeficiency virus

Area of Science:

• Cardiology
• Immunology
• Transplantation

Background:

• Human immunodeficiency virus-positive (HIV+) patients are often excluded from heart transplantation (HT) due to limited outcome data.
• Significant advancements in HIV management have improved long-term survival and comorbidities in HIV+ individuals.

Purpose of the Study:

• To evaluate post-transplant outcomes in HIV+ heart transplant recipients.
• To compare outcomes between HIV+ and HIV- heart transplant recipients.
• To assess the feasibility and outcomes of heart transplantation in a broader US cohort.

Main Methods:

• Retrospective analysis of 41 adult HIV+ heart transplant recipients from January 2004 to March 2017 using UNOS data.
• Kaplan-Meier survival analysis and comparison of outcomes between patients with and without bridge-to-transplant ventricular assist devices (BTT-VAD).
• Propensity score matching to compare HIV+ recipients with HIV- recipients with idiopathic dilated cardiomyopathy.

Main Results:

• One- and 5-year survival rates for HIV+ HT recipients were 85.9% and 77.3%, respectively.
• No significant difference in survival was observed between BTT-VAD and no-BTT-VAD groups.
• Five-year rates of cardiac allograft vasculopathy (CAV) and malignancy were 32% and 19%, comparable to the general HT population.
• Propensity-matched analysis showed no significant difference in post-HT survival up to 5 years between HIV+ and HIV- recipients.

Conclusions:

• Post-transplant survival for HIV+ heart transplant recipients is excellent and comparable to HIV-negative patients.
• Rates of CAV and malignancy are similar to the overall heart transplant population, challenging previous concerns.
• These findings advocate for increased HT center participation and improved access to transplantation for suitable HIV+ candidates.