The 2013 HIV Organ Policy Equity (HOPE) Act expanded kidney transplantation eligibility for people with HIV/AIDS (PWH), marking a significant milestone and necessitating updated reviews on the outcomes of renal transplantations on PWH. To assess kidney transplantation outcomes in PWH, including patient and graft survival, graft rejection, and infection rates. We conducted a systematic review of studies published between 1990 and 2023. Included studies reported on kidney transplantation outcomes in PWH, focusing on graft and patient survival, rejection, and infections and compared with HIV-negative kidney graft recipients. Out of 743 studies, 49 prospective and retrospective studies were included, with data of 6174 PWHs analysed. At one year post-transplant, patient survival in PWH was high at 94% (95% CI: 92.83–94.97%), with a decrease to 83% beyond five years (95% CI: 76.50–87.64%). Graft survival exhibited similar trends. Graft rejection rates increased from 26% in one year to 39% over five years. There were no significant differences in short- to medium-term recipient survival rates between PWH and HIV-negative individuals. Kidney transplantation is a viable option for PWH, with short- to medium-term outcomes comparable to HIV-negative recipients. Future research should focus on optimizing long-term outcomes. 1. Kidney transplantation is a viable option for people living with HIV/AIDS. 2. Short-term patient and graft survival is comparable to HIV-negative recipients but both declines after 5 years. 3. Graft rejection for people with HIV increases over time, reaching 39% at five years post-transplant, with a consistently higher risk than in HIV-negative recipients. 4. Avoiding protease inhibitors in antiretroviral therapy may improve graft survival. 5. Hepatitis C co-infection negatively impacts transplant outcomes.
Leung et al. (2025) studied this question.