Heart Transplantation Survival Outcomes of HIV Positive and Negative Recipients.

Journal Article (Journal Article)

BACKGROUND: In the era of antiretroviral therapy, HIV-positive patients have reduced mortality from HIV infection and increased morbidity from end-stage heart failure. The number of HIV-positive heart transplantation recipients remains scant. Long-term survival has not been rigorously studied. We compared survival outcomes of heart transplantation in HIV-positive recipients with those of HIV-negative recipients. METHODS: Clinical data from all adult heart transplantations were extracted from the United Network for Organ Sharing dataset. The impact of recipient HIV status was analyzed with Cox proportional hazards modeling, 1:3 propensity score matching, and Kaplan-Meier survival analysis. RESULTS: Seventy-five HIV-positive recipients and 29,848 HIV-negative recipients were identified. Race distributions differed between the recipient groups, with black patients comprising a larger proportion of the HIV-positive recipient group (46.7% vs 20.9%, P < .001). The mean year of transplant was significantly later in the HIV-positive recipient group. The rate of acute rejection in the HIV-positive group was higher than in the HIV-negative group (38.7% vs 17.7%, P < .001), as was rate of antirejection treatment administration such as intravenous immunoglobulin or plasmapheresis (26.7% vs 10.4%, P < .001). There was no difference in 30-day, 1-year, and 5-year survival of HIV-positive recipients vs HIV-negative recipients. Recipient HIV infection was not a significant covariate in predicting survival in a Cox proportional hazards model. CONCLUSIONS: Short-term and moderate-term survival after heart transplantation is similar for HIV-positive recipients and HIV-negative recipients, although data are very limited. This finding suggests that HIV-positive recipients should not be excluded from transplant candidacy solely based on HIV serostatus.

Full Text

Duke Authors

Cited Authors

  • Doberne, JW; Jawitz, OK; Raman, V; Bryner, BS; Schroder, JN; Milano, CA

Published Date

  • May 1, 2021

Published In

Volume / Issue

  • 111 / 5

Start / End Page

  • 1465 - 1471

PubMed ID

  • 32946847

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2020.06.120

Language

  • eng

Conference Location

  • Netherlands