Purpose: Increased risk organ donors are being more commonly utilized given organ shortages. However, there is a small risk of transmission of diseases such as HIV due to the “window period” in recently infected donors, during which time NAT testing will remain negative. The objective of this study was to determine the efficacy and safety of post-exposure prophylaxis (PEP) in liver transplant recipients receiving organs from donors potentially infected during this “window period”.

Methods; This was a single-center, retrospective case series with a study period from February 2016 to July 2017. Adult subjects who received PEP after liver transplantation from increased risk donors, with NAT testing negative but with recent potential exposure to HIV were included. The primary endpoint was efficacy of PEP in prevention of HIV infection during the first year post-transplant. Secondary endpoints included development of adverse events from PEP, development of donor-derived hepatitis B virus (HBV) and hepatitis C virus (HCV), all-cause mortality, and transplant rejection.

Results: A total of 18 liver transplant recipients were included in the study. Two or three-drug post-exposure prophylaxis regimens for 28 days post-transplant included tenofovir with dolutegravir or raltegravir, with or without emtricitabine. 89% of subjects completed the full 28 days of therapy, with 2 subjects stopped early due to concerns of hepatotoxicity and nephrotoxicity. Of the patients who completed therapy, an average of 1.1 doses were missed. To date, there is no evidence of donor-derived infection with HIV, HCV, or HBV based on virologic testing. All patients are alive at study conclusion. One patient had acute rejection (RAI score of 4) that was treated and resolved. The most common side effects were minimal and potentially attributable to other causes and included diarrhea, renal impairment, nausea, fatigue, gastrointestinal pain, and peripheral neuropathy.

Conclusion: PEP may be used safely in prevention of HIV transmission, and with minimal adverse events, in liver transplant recipients from increased risk donors within the infectious “window period”.

CITATION INFORMATION: Nolan A., Yarosh D., Shaikh S. Mitigating Risk: Post-Exposure Prophylaxis in Liver Transplant Recipients from Donors with Potential Infectious Exposure Am J Transplant. 2017;17 (suppl 3).

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