Heart Transplantation in Human Immunodeficiency Virus–Positive Patients

Uriel, Nir; Jorde, Ulrich P.; Cotarlan, Vlad; Colombo, Paolo C.; Farr, Maryjane; Restaino, Susan W.; Lietz, Katherine; Naka, Yoshifuma; Deng, Mario C.; Mancini, Donna

doi:10.1016/j.healun.2009.04.005

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 28, Issue 7 , Pages 667-669, July 2009

Heart Transplantation in Human Immunodeficiency Virus–Positive Patients

Nir Uriel, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
Ulrich P. Jorde, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
Vlad Cotarlan, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
Paolo C. Colombo, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
Maryjane Farr, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
Susan W. Restaino, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
Katherine Lietz, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
Yoshifuma Naka, MD, PhD
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
Mario C. Deng, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
Donna Mancini, MD
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
- Reprint requests: Donna Mancini, MD, 622 W 168 St, New York, NY 10032. Telephone: 212-305-4629. Fax: 212-305-2591

Received 26 November 2008; received in revised form 17 March 2009; accepted 7 April 2009. published online 08 May 2009.

Background

Human immunodeficiency virus (HIV) infection is widely considered a contraindication for cardiac transplantation. However, with the newer anti-retroviral drugs, the estimated 10-year survival after seroconversion is exceeds 90%. This case series describes the intermediate range outcome of HIV-positive cardiac transplant recipients.

Methods

A retrospective analysis of 1679 cardiac transplant patients was undertaken to identify HIV-positive recipients.

Results

Seven patients were identified. Five (4 men) were diagnosed with HIV before transplantation and 2 patients seroconverted after transplantation. Dilated cardiomyopathy was the indication for transplant in all patients. The 5 HIV recipients were aged 42 ± 8 years, and time after HIV seroconversion averaged 9.5 years. All underwent cardiac transplantation as high-risk candidates. The CD4 count was 554 ± 169 cells/μl, and viral load was undetectable in all patients at the time of transplantation. Two patients seroconverted to HIV-positive status at 1 and 7 years after transplant. No AIDS-defining illness was observed in any patient before or after transplant. Six patients received highly active anti-retroviral therapy. Viral load remained low in the presence of immunosuppression. All patients are alive with a follow-up from transplant of 57 ± 78.9 months.

Conclusion

Excellent intermediate term outcome is noted in carefully selected HIV-positive patients. No significant AIDS-related infections or complications occurred.