HOPE in every breath and heartbeat: Understanding transplant eligibility, access barriers, and clinical outcomes in thoracic transplantation in persons with HIV.

Background: Persons with human immunodeficiency virus (PWH) are living longer, leading to increased end-organ disease from chronic illness. Organ transplantation improves survival in patients with end-organ disease yet remains a constrained resource due to limited access. We aimed to better understand barriers to transplantation for thoracic end-organ disease in PWH. Methods: We performed a retrospective study of patients referred to our center for consideration of thoracic organ transplant and assessed the factors associated with transplant eligibility in candidates with human immunodeficiency virus (HIV). We also assessed clinical outcomes in PWH progressing to transplant. Results: Over a 10-year period, 30 HIV-seropositive candidates and 10,905 HIV-seronegative candidates were referred to our center. Of candidates referred, 40% (12 of 30) of HIV-seropositive candidates were waitlisted compared to 20% (2,172 of 10,905) of HIV-seronegative candidates ( Conclusions: HIV-seropositive thoracic transplant candidates were more likely to be waitlisted compared to HIV-seronegative candidates. Progression to transplant and waitlist times were similar between candidates with and without HIV. Our study suggests that HIV alone was not a significant barrier to transplantation in PWH when referred and evaluated for thoracic organ transplantation.