HIV TRANSMISSION BY ORGAN AND TISSUE-TRANSPLANTATION

Purpose: Published reports in English of HIV infection in organ and tissue recipients were reviewed to examine (1) the effect of donor screening, allograft type, and allograft processing on risk of HIV transmission by transplantation; (2) the antibody response to HIV infection in organ recipients taking antirejection therapy; and (3) survival following transplantation for HIV-infected organ recipients. Data extraction: Date of transplant, timing of HIV infection in relation to transplant, type of allograft, type of antirejection therapy, duration of follow-up, time to death, and time to antigen and antibody appearance were recorded for each of 32 reports. Results: HIV transmission associated with transplantation of kidney (n = 50), liver (n = 13), heart (n = 6), pancreas (n = 1), bone (n = 4), and skin (n = 1) has been reported. In all but 14 cases, transplantation occurred before routine donor screening for HIV antibody began. In addition, 24 cases of an organ transplant after the recipient became HIV-infected have been reported. Non-transmission of HIV from HIV-infected donors has also been reported in recipients of corneas (n = 9), bone (n = 26), other musculoskeletal tissue (n = 3), dura mater (n = 3), and kidneys (n = 2). Of 40 recipients with organ transplantation-associated infection who were tested for HIV antibody within 6 months of transplantation, 34 (85%) tested positive; only one recipient remained seronegative more than 6 months after transplantation. Estimated 1- and 5-year survival following transplantation for 61 HIV-infected kidney recipients was 90 and 50%, respectively. Conclusions: With current screening practices, HIV transmission by transplantation is rare. The transmission risk appears lower for recipients of processed or avascular tissues. The antibody response to HIV infection in organ recipients taking immunosuppressive therapy is similar to that reported in other infected people.