The feasibility of lung transplantation in HIV-seropositive patients

Ryan M. Kern, Harish Seethamraju, Paul D. Blanc, Niraj Sinha, Matthias Loebe, Jeff Golden, Jasleen Kukreja, Scott Scheinin, Steven Hays, Mary Ellen Kleinhenz, Lorri Leard, Charles Hoopes, Jonathan P. Singer

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

Rationale: HIV seropositivity has long been considered a contraindication to lung transplantation, primarily because of the potential risks of added immunosuppression. In the past decade, however, experience with kidney and liver transplantation in the setting of HIV infection, with achievement of satisfactory outcomes, has grown considerably. This promising development has created a need to reconsider this contraindication to lung transplantation. Objectives: There is presently limited evidence upon which to base medical decision-making regarding lung transplantation in individuals with HIV infection. In our present study, we wished to extend the existing literature by reporting the outcomes of three individuals with HIV infection who underwent lung transplantation at two centers. Methods: We compiled data for a case series of three HIV infected subjects undergoing lung transplantation at two centers. Measurements and Main Results: We reviewed medical records to investigate the effects of lung transplantation on the course of HIV infection, the development of HIV-related opportunistic infections or malignancies, the occurrence of lung transplant and HIV drug interactions, and the extent of acute rejection. Subject 1, who underwent transplantation for HIV associated pulmonary arterial hypertension, experienced recalcitrant acute rejection requiring a lymphocyte-depleting agent with subsequent rapid development of bronchiolitis obliterans syndrome. Subjects 2 and 3, who underwent transplantation for idiopathic pulmonary fibrosis, experienced mild acute rejection but remain free from chronic rejection at 4 and 2 years after transplant, respectively. Conclusions: Lung transplantation may be feasible for carefully selected patients in the setting of controlled HIV infection. On the basis of our experience with three patients, we caution that acute graft rejection may be more common in such patients.

Original languageEnglish (US)
Pages (from-to)945-950
Number of pages6
JournalAnnals of the American Thoracic Society
Volume11
Issue number6
DOIs
StatePublished - Jul 1 2014
Externally publishedYes

Keywords

  • Acute rejection
  • Human immunodeficiency virus
  • Idiopathic pulmonary fibrosis
  • Lung transplantation
  • Pulmonary arterial hypertension

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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  • Cite this

    Kern, R. M., Seethamraju, H., Blanc, P. D., Sinha, N., Loebe, M., Golden, J., Kukreja, J., Scheinin, S., Hays, S., Kleinhenz, M. E., Leard, L., Hoopes, C., & Singer, J. P. (2014). The feasibility of lung transplantation in HIV-seropositive patients. Annals of the American Thoracic Society, 11(6), 945-950. https://doi.org/10.1513/AnnalsATS.201402-083OC