Current situation of solid organ transplantation from HIV-positive donors to HIV-positive recipients in Europe: the Spanish perspective

Jose M Miro; Nerea L Amondarain; Lucia Serrano; Jon Salmanton-Garcia; Christian Manzardo; Daniela Malano-Barletta; David Paredes-Zapata; Antonio Guerra-Maio; Jean-Paul Stahl; Marta Subirana; Pablo Ruiz; Constantino Fondevila; Federic Cofán; Angela González; Mireia Musquera; Beatriz Mahillo; Gloria de la Rosa; Rosario Marazuela; Antonio Rimola; Asuncion Moreno; Spanish LT/KT in HIV-Infected Patients Working Group investigators and the UEMS-ID investigators

doi:10.1016/j.cmi.2025.08.025

Current situation of solid organ transplantation from HIV-positive donors to HIV-positive recipients in Europe: the Spanish perspective

Clin Microbiol Infect. 2025 Sep 2:S1198-743X(25)00423-9. doi: 10.1016/j.cmi.2025.08.025. Online ahead of print.

Authors

Jose M Miro¹, Nerea L Amondarain², Lucia Serrano³, Jon Salmanton-Garcia⁴, Christian Manzardo⁵, Daniela Malano-Barletta⁵, David Paredes-Zapata⁵, Antonio Guerra-Maio⁶, Jean-Paul Stahl⁷, Marta Subirana⁵, Pablo Ruiz⁵, Constantino Fondevila⁵, Federic Cofán⁵, Angela González⁵, Mireia Musquera⁵, Beatriz Mahillo⁸, Gloria de la Rosa⁸, Rosario Marazuela⁸, Antonio Rimola⁵, Asuncion Moreno⁵; Spanish LT/KT in HIV-Infected Patients Working Group investigators and the UEMS-ID investigators

Affiliations

¹ Hospital Clinic-IDIBAPS-University of Barcelona, Barcelona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain; Reial Academia de Medicina de Catalunya, Barcelona, Spain. Electronic address: jmmiro@ub.edu.
² Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
³ Grupo de Estudio de Sida (GESIDA), Madrid, Spain.
⁴ Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
⁵ Hospital Clinic-IDIBAPS-University of Barcelona, Barcelona, Spain.
⁶ Unidade Local de Saúde da Região de Aveiro, Aveiro, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
⁷ University Grenoble Alpes, Grenoble, France.
⁸ Organización Nacional de Trasplante (ONT), Madrid, Spain.

PMID: 40907699
DOI: 10.1016/j.cmi.2025.08.025

Abstract

Objectives: There is limited information on the use of organs from HIV-positive donors (HIV D+) for HIV-positive recipients (HIV R+) in Europe. In some countries, the use of HIV D+ organs is prohibited by law. This study aimed to assess the attitudes of Spanish kidney transplant (KT) and liver transplant (LT) teams towards HIV D+/R + KT/LT through a nationwide survey, and to evaluate the current situation across Europe regarding legislation and reported cases.

Methods: In 2018 and 2019, 2 surveys were conducted across Spain's 24 LT and 39 KT centres, respectively. Specialists in HIV/infectious diseases, nephrology/hepatology, urology/liver surgery and transplant coordination completed a questionnaire, with responses analysed by speciality. We also consulted European representatives on national legal frameworks regarding HIV D+/R+ and conducted a narrative review of published cases (2000-2025).

Results: The Spanish survey was answered by at least one member of all Spanish LT and KT teams (63/63, 100%). Most specialists who responded to the survey (167/252; 66%) supported using organs from virologically suppressed (VS) HIV D+ on antiretroviral therapy, high-risk and serodiscordant couples, but not from non-VS HIV D+, for HIV R+. All respondents endorsed implementing a dedicated consent form, and a majority expressed willingness to participate in an HIV D+/R+ trial. No major differences were observed between the LT and KT teams. At the European level, the use of organs from HIV D+ was permitted, prohibited or unregulated in 6 (17%), 11 (31.5%) and 18 (51.5%) countries, respectively. Ten HIV D+/R+ transplants (6 kidneys and 4 livers) have been published, with good 1-year outcomes.

Discussion: The surveyed Spanish specialists would agree on using organs from VS HIV D+ for HIV D+/R+ transplants. This procedure is only legally allowed in very few European countries. These results should promote changes in donor laws across Europe.

Keywords: Europe; HIV-Positive donors; HIV-Positive recipients; Kidney transplantation; Liver transplantation; Spain; Survey.