Donors with human immunodeficiency virus and hepatitis C virus for solid organ transplantation: what's new

Area of Science:

• Organ transplantation
• Infectious disease research
• Public health policy

Background:

• The HOPE Act and direct-acting antiviral (DAA) therapies have expanded organ donor criteria.
• Donors with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are now viable for transplantation.
• This expands opportunities for patients on organ waitlists.

Purpose of the Study:

• To provide updates on recent studies in solid organ transplantation (SOT) using donors with HIV and HCV.
• To evaluate the safety and efficacy of using organs from HIV- and HCV-positive donors.
• To assess the impact on organ availability and waitlist mortality.

Main Methods:

• Review of pilot studies and clinical outcomes in SOT from HIV-positive donors to HIV-positive recipients (HIV D+/R+).
• Analysis of transplantation outcomes using HCV-positive donors (HCV D+) in recipients without HCV (HCV D-/R-), with DAA therapy.
• Inclusion of both abdominal and thoracic transplantation data.

Main Results:

• HIV D+/R+ kidney and liver transplantation shows robust patient survival and comparable graft survival to standard donors.
• No increased rates of HIV breakthrough were observed in HIV D+/R+ recipients.
• Transplantation using HCV D+/R- donors with DAAs demonstrates excellent outcomes in both abdominal and thoracic SOT.
• Utilization of HIV D+ organs has been lower than anticipated.

Conclusions:

• Transplantation from HIV D+/R+ donors is a safe and effective clinical option.
• Transplantation from HCV D+/R- donors with DAAs shows excellent outcomes.
• These practices support mitigating organ shortage and reducing waitlist mortality.