14th International AIDS Conference


Barcelona, Spain — July 7-12, 2002

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[TITLE:] Solid organ transplantation in HIV-infected recipients: forty-seven cases in the HAART-era

[AUTHOR(S):] M.E. Roland, L. Carlson, P. Stock1, M. Ragni, S. Rohal, J. Fung2, M. Keller, B. Murphy, L. Kim-Schluger, J. Jacobson3, A. Humar4, T. Pruett, C. Berg5, A. Lu6, W. Bennett, M. Allee7, K. Olthoff8, M.S.A. Kumar, M. Gold, A. Damask9, J.W. Light10, R. Redfield11

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrB1060

BACKGROUND: The safety and efficacy of transplantation in the HAART-era are being evaluated in a prospective study. 47 transplants (tx) occurred at collaborating centers prior to study initiation.

METHODS: Collection of retrospective data from liver (L) and kidney (K) tx recipients who would have met study eligibility criteria, including opportunistic infection (OI), CD4+ T cells, HIV RNA, graft function, rejection. Eligibility criteria: pre-tx CD4+ T-cell > 200 cells/ mm3 (K) or > 100 cells/mm3 (L), undetectable HIV RNA (K), or detectable HIV RNA off HAART with past suppression (L), and no history of OI. Subjects not meeting eligibility criteria are presented separately.

RESULTS: 8 tx centers identified 39 eligible recipients (18 L; 21 K). Median follow-up = 277 (7 - 1548) days. Median baseline CD4 count = 344 cells/mm3 (103 - 973) in L recipients and 465 cells/mm3 (200 -1054) in K. 34 subjects had undetectable HIV RNA at baseline. Median HIV RNA in the other 5 = 24,000 (51 - 115,776). There were 4 deaths (HCV, graft failure, rejection due medication interactions, and ischemic bowel) and 1 OI (CMV esophagitis at a CD4 cell count of 200). 1 L required re-transplantation, and 1 K lost his graft. All others (95%) remain viable, although 10 subjects (25%) have experienced rejection. Median follow-up CD4 count = 280 (89 - 715) cells/mm3 in L and 452 (74 - 1300) cells/mm3 in K. Median HIV RNA = <50; 5 subjects have detectable HIV RNA (median = 357; 80 - 24,000). Complications include recurrent HCV, endocarditis, pneumonia, pancreatitis, skin cancer, diabetes, and toxic immunosuppressive levels. Among the 8 patients did not meet inclusion criteria, 3 K had detectable HIV RNA, 1 L had CD4 < 100, and 2 had OI history (PCP/PCP + KS); all are alive at mean 376 days (27 - 1244). 1 K with unrecognized advanced HIV + MAC and 1 L with pre-tx encephalopathy died with PML.

CONCLUSIONS: Patient and graft survival for selected HIV-infected tx recipients are good in HAART era.

Presenting author: Michelle Roland

1Univ of California, San Francisco, Ward 84, Building 80, San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA 94110, United States.

2Univ of Pittsburgh, Pittsburgh, United States.

3Mt. Sinai Medical Center, New York, United States.

4Univ of Minnesota, Minneapolis, United States.

5University of Virginia, Charlottesville, United States.

6Georgetown University, Washington, DC, United States.

7Legacy Good Samaritan Hospital, Portland, United States.

8University of Pennsylvania, Philadelphia, United States.

9Hahnemann, Philadephia, United States.

10Washington Hospital Center, Washington, DC, United States.

11Univ of Maryland, Baltimore, United States.

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