The HIV Organ Policy Equity (HOPE) Act allows HIV-infected donor (HIV D+) organs to be transplanted into HIV+ recipients (HIV R+) under research protocols. We evaluated the safety and efficacy of deceased HIV D+/R+ kidney transplant (KT) in the HOPE in Action Multicenter Pilot Trial (NCT02602262).

METHODS: HIV+ individuals meeting standard and HIV-specific criteria for KT were enrolled. Kidneys from HIV D+, HIV D- and HIV false-positive (FP) donors were allocated by match run among consented patients. Post-transplant outcomes were compared between HIV D+/R+ and HIV D-/R+ (the latter included HIV FP later confirmed as true negatives). Renal biopsies were done at 3 and 12 months for HIV D+/R+. Rejection was measured as time-to-event.

RESULTS: From 3/2016 to 11/2017, 12 HIV D+/R+ and 39 HIV D-/R+ KTs (15 which involved HIV FP donors) occurred at five centers. HIV R+ were similar in age, sex, race, HIV RNA, CD4 count, and HCV RNA (p-values>0.05, Table 1). Median follow up time was 7.0 months (2.0-12.4). No deaths occurred. There was 1 graft failure from renal vein thrombosis on post-operative day 2 in the HIV D+/R+ arm. No HIV virologic failures occurred. There were 3 AIDS-defining infections in the HIV D-/R+ group only. There were 9 rejection episodes, all in KTs without ATG induction: 6 in the HIV D+/R+ arm and 3 in the HIV D-/R+ arm (50% vs 7.7%, p=0.001) (Figure).

CONCLUSION: We report the first HIV D+/R+ kidney transplants under the HOPE Act with excellent patient and graft survival to date. Rejection rates were high however this might be reduced with the use of ATG.

CITATION INFORMATION: Durand C., Bowring M., Tobian A., Brown D., Desai N., Bagnasco S., Ostrander D., Redd A., Huprikar S., Haydel B., Lerner S., Florman S., Chandran S., Chao A., Locke J., Mehta S., Freidman R., Turgeon N., Massie A., Segev D. Outcomes after HIV+ Kidney Transplant: A HOPE in Action Study Am J Transplant. 2017;17 (suppl 3).

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