In order to expand the availability of organs for HIV-positive patients, successful transplantation of kidneys and livers from HIV-positive donors into selected HIV-positive recipients was recently reported. We describe the first Italian transplant experience from HIV-positive donors to HIV-positive recipients. The Italian National Centre for Transplantation has allowed organ transplantation between HIV-positive deceased donors and recipients since May 2017 and has designed a national protocol. Donor eligibility criteria required: a known history of HIV infection and prior antiretroviral therapy (cART); no evidence of AIDS-defining illness; pre-implant organ donor organ biopsy.

On May 2017, three HIV-positive patients (1 M, 2 F; 2 Caucasian, 1 African; age 41, 45 and 50 yrs respectively) underwent organ transplantation (2 kidney and 1 liver) from an HIV-positive donor, after a median waiting time of 20 months (range 11-27). The donor (M, age 53 yrs, cause of death: ischemic stroke) was followed by a specialized center for HIV treatment and was on cART with abacavir [ABC], lamivudine [3TC], dolutegravir [DTG]. Recipients' median CD4 cells count at the time of transplantation was 300/[micro]L (range 236-635) and the HIV-RNA was undetectable in all. Immunosuppressive regimen for the kidney recipients was based on induction with basiliximab, followed by Tacrolimus, Mycophenolic acid and steroids which were stopped at 3 months after transplant; in the liver recipient the induction was with basiliximab plus steroids followed by tacrolimus plus everolimus. cART was started in the kidney recipients after transplantation with ABC, 3TC and DTG and with Tenofovir alafenamide (TAF)/ Emtricitabine (FTC) and DTG in the liver recipient. At 6 months after transplantation HIV-RNA remains undetectable in all patients and the median CD4 count is 325/[micro]L. The transplant outcome at 6 months post-transplantation is excellent, with normal kidney (eGFR = 52 and 54 ml/min, respectively) and liver function (AST = 24 U/L and ALT = 38 U/L). No acute rejection was observed. Our study confirms excellent short-term results of kidney and liver transplantation from HIV-positive donors.

CITATION INFORMATION: Grossi P., Dalla Gasperina D., Petrolo A., Lombardi D., Balsamo M., Moioli M., Travi G., Merli M., Ferla F., Tozzi M., De Carlis L., Carcano G., Puoti M., Nanni Costa A. HIV-Positive Donors to HIV-Positive Transplant Recipients: The Italian Experience Am J Transplant. 2017;17 (suppl 3).

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