SESSION TITLE: Late Breaking Abstracts
SESSION TYPE: Slide Presentation
PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM
PURPOSE: Human immunodeficiency virus seropositivity (HIV+) has been considered a contraindication to lung transplantation (LT) primarily due to potential risks of iatrogenic immunosuppression. With the recent passage of the HIV Organ Policy Equity (HOPE) Act on November 21, 2013, the donation of HIV+ organs for transplant in HIV+ recipients is now legal in the USA. As a result there may be an increase in donors for HIV+ recipients. However, there remains only one fully published case report of LT in an HIV+ patient, limiting the evidence base with which to guide medical decision making. We report 3 HIV+ patients at two different medical centers who underwent LT.
METHODS: Based on the experience of two centers, we compiled data for a case series of three HIV+ patients who underwent LT. Data was abtracted from medical records from the lung transplant programs at the University of California, San Francisco and Houston Methodist Hospital. We reviewed charts to investigate: 1.) Does LT affect the course of HIV infection? 2.) Do LT recipients demonstrate an increased risk for HIV-related opportunistic infections or malignancies? 3.) Can drug-drug interactions between immunosuppressive and antiretroviral medications be easily managed? 4.) Are HIV+ LT recipients at higher risk for acute rejection, similar to HIV+ liver and kidney transplant recipients?
RESULTS: Patient 1, transplanted for HIV-associated pulmonary arterial hypertension, experienced recalcitrant acute rejection and the rapid development of bronchiolitis obliterans syndrome. Patients 2 and 3, transplanted for idiopathic pulmonary fibrosis, experienced mild acute rejection but remain free from chronic rejection at 3.5 and 1.5 years after transplant, respectively. We observed no instances of HIV-associated opportunistic infections or malignancies in any of the three cases. Drug-drug interactions, although challenging, were manageable. Unexpectedly, all 3 patients showed signs of pulmonary arterial vasculopathy on explant; all three also had at least one episode of acute cellular rejection in the first year after LT. In Patients 2 and 3, rejection was easily managed and did not recur, whereas Patient 1 required a lymphocyte-depleting agent.
CONCLUSIONS: Based on this limited experience, LT appears feasible in the setting of HIV, although acute rejection appears to be common.
CLINICAL IMPLICATIONS: As seen in other solid organ transplant populations, LT in the setting of HIV may be associated with good outcomes, but there may be increased rates of acute rejection.
DISCLOSURE: The following authors have nothing to disclose: Ryan Kern, Harish Seethamraju, Paul Blanc, Neeraj Sinha, Matthias Loebe, Jeffrey Golden, Jasleen Kukreja, Scott Scheinin, Steve Hays, Kleinhenz Mary Ellen, Leard Lorri, Charles Hoopes, Jonathan Singer
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