Lung Transplant in Patients With Human Immunodeficiency Virus: A Case Series

Historically, patients with human immunodeficiency virus (PWH) were at higher risk for pulmonary morbidities than patients without HIV. Lung transplantation in PWH has been limited by uncertain outcomes and a lack of guidelines for transplantation and immunosuppression. However, several case reports in the United States and Europe have demonstrated that lung transplantation in PWH is feasible. Although there remain concerns regarding these patients as higher-risk recipients, lung transplantation is feasible with careful modification of immunosuppression and close monitoring. We performed lung transplantation on three PWHs and analyzed their post-transplant outcomes to determine the feasibility of lung transplant in PWH. We found that all three patients (mean age 59, SD 10.98) with HIV underwent lung transplantation. Two of the three patients experienced acute cellular rejection that resolved with intravenous corticosteroids. None had long-term complications including chronic rejection, antibody-mediated rejection, or infections. All three patients maintained baseline HIV therapy following transplantation with adequate HIV disease control. Although PWH has an increased risk of pulmonary comorbidities compared to the general population, lung transplantation appears to be a feasible treatment option supported by the growing body of literature and the three cases described here.