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Solid organ transplantation in the HIV‐infected patient

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Published 2004 in American Journal of Transplantation

ABSTRACT

For HIV infected patients with access to the newer regimens of highly active antiretroviral therapy (HAART), mortality rates and morbidity due to many opportunistic infections have plummeted. These advances have revealed, however, substantial morbidity and mortality attributable to end stage renal and liver disease (ESRD/ESLD) that is unaffected by improved control of HIV infection. Until very recently, HIV infection was considered an absolute contraindication to solid organ transplantation, leaving patients with ESLD no options for survival, and those with ESRD the requirement for peritoneal or hemodialysis. For reasons described below, this view is rapidly changing (1–9). A number of transplant centers across the USA now offer transplantation to carefully selected patients infected with HIV, and an NIH supported multicenter trial has been initiated to assess the safety and efficacy of liver and renal transplantation in HIV-positive recipients. The approach adopted by this multicenter group, the Cooperative Clinical Trials in Adult Transplantation (CCTAT), is presented in these practice guidelines. While the field of transplantation and transplant related infections has always been a rapidly evolving one, it must be stressed that this is particularly the case in the setting of HIV infection. Newly accumulating data regarding drug interactions, opportunistic infections, and graft and patient survival will mandate that these recommendations be frequently updated.

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