Lung transplantation in HIV seropositive recipients: An analysis of the UNOS registry

Background: Experience with lung transplantation (LT) in patients with human immunodeficiency virus (HIV) is limited. Many studies have demonstrated the success of kidney and liver transplantation in HIV-seropositive (HIV+) patients. Our objective was to conduct a national registry analysis comparing LT outcomes in HIV+ to HIV-seronegative (HIV−) recipients. Methods: The United Network for Organ Sharing database was queried to identify LTs performed in adult HIV+ patients between 2016 and 2023. Patients with unknown HIV status, multiorgan transplants, and redo transplants were excluded. The primary endpoints were mortality and graft rejection. Survival time was analyzed using Kaplan–Meier analysis. Results: The study included 17 487 patients, 67 of whom were HIV+. HIV+ recipients were younger (59 vs. 62 years, p =.02), had higher pulmonary arterial pressure (28 vs. 25 mm Hg, p =.04), and higher lung allocation scores (47 vs. 41, p =.01) relative to HIV− recipients. There were no differences in graft/recipient survival time between groups. HIV+ recipients had higher rates of post-transplant dialysis (18% vs. 8.4%, p =.01), but otherwise had similar post-transplant outcomes to HIV-recipients. Conclusions: This national registry analysis suggests LT outcomes in HIV+ patients are not inferior to outcomes in HIV− patients and that well-selected HIV+ recipients can achieve comparable patient and graft survival rates relative to HIV− recipients.