Trends, center level practice, and outcomes of heart transplantation in people with HIV
Date:
04/24/2026
Locations:
Citation:
Liang T, Nauroz Z, Bowring MG, Saeed O, Farr M, La Hoz RM, Hall S, Hashmi Z, Aslam S, Habal M, Werbel WA, Rodrigues MM, Hemmige VS, Segev DL, Massie A, Durand CM. Trends, center level practice, and outcomes of heart transplantation in people with HIV. JHLT Open. 2026 Apr 24;13:100576. doi: 10.1016/j.jhlto.2026.100576. PMID: 42211991; PMCID: PMC13213271.
Abstract
Background: Kidney and liver transplantation have become standard of care for medically eligible people with HIV (PWH) with end-organ disease in the US, but data on heart transplantation (HT) in PWH remains limited.
Methods: We used US national registry data 2014-2024 to identify 197 recipients with HIV (HIV R+) vs 34,213 without HIV (HIV R-) and used nonparametric tests of trend and Gini coefficients to quantify changes over time. Adjusted Cox regression, stratified by transplant centers, and modified Poisson regression were used to compare transplant outcomes in HIV R+ vs HIV R-.
Results: Annual HIV R+ HT increased from 0.3% in 2014 to 0.9% of HTs in 2024 (p<0.001). Center clustering decreased slightly over time: 14/135 HT centers performed 80% of HIV R+ HT in 2014-2019 (Gini 0.80) and 35/143 performed 80% in 2020-2024 (Gini 0.72). Compared to HIV R-, HIV R+ were younger, more often Black. Prior to 2020, 1-year patient survival was 85% HIV R+ vs 91% HIV R- (adjusted hazard ratio for mortality [aHR] 1.30, 95% CI: [0.84-2.01]), and 1-year rejection was 27% vs 20% (adjusted relative risk [aRR] 1.35 [0.86-2.14]). After 2020, 1-year patient survival was 90% HIV R+ vs 92% HIV R-, (aHR 1.05 [0.66-1.65]), and 1-year rejection was 15% vs 15% (aRR 1.04 [0.67-1.61]).
Conclusions: The practice of HT in PWH has expanded over time, though it is still clustered, occurring at 72 limited number of programs. Patient survival and rejection among HIV R+ are comparable to HIV R-.
Methods: We used US national registry data 2014-2024 to identify 197 recipients with HIV (HIV R+) vs 34,213 without HIV (HIV R-) and used nonparametric tests of trend and Gini coefficients to quantify changes over time. Adjusted Cox regression, stratified by transplant centers, and modified Poisson regression were used to compare transplant outcomes in HIV R+ vs HIV R-.
Results: Annual HIV R+ HT increased from 0.3% in 2014 to 0.9% of HTs in 2024 (p<0.001). Center clustering decreased slightly over time: 14/135 HT centers performed 80% of HIV R+ HT in 2014-2019 (Gini 0.80) and 35/143 performed 80% in 2020-2024 (Gini 0.72). Compared to HIV R-, HIV R+ were younger, more often Black. Prior to 2020, 1-year patient survival was 85% HIV R+ vs 91% HIV R- (adjusted hazard ratio for mortality [aHR] 1.30, 95% CI: [0.84-2.01]), and 1-year rejection was 27% vs 20% (adjusted relative risk [aRR] 1.35 [0.86-2.14]). After 2020, 1-year patient survival was 90% HIV R+ vs 92% HIV R-, (aHR 1.05 [0.66-1.65]), and 1-year rejection was 15% vs 15% (aRR 1.04 [0.67-1.61]).
Conclusions: The practice of HT in PWH has expanded over time, though it is still clustered, occurring at 72 limited number of programs. Patient survival and rejection among HIV R+ are comparable to HIV R-.