Infections After Kidney Transplantation from Donors with HIV to Recipients with HIV: Insights, Prevention, and the Path Forward

(See the Major Article by Arant et al on pages e549–57.) Kidney transplantation (KT) from donors with human immunodeficiency virus (HIV) started in the United States in 2016 under the US congressional HIV Organ Policy Equity (HOPE) Act [1]. A pioneering clinical trial performed by HOPE in action investigators showed that KT in persons with HIV (PWH) from deceased donors with HIV was safe, and rates of organ rejection, graft survival, serious adverse events, infections, surgical complications, and cancer were comparable between recipients of donors with HIV (HIV+/+) and those without HIV (HIV−/+) [2]. The use of kidney grafts from donors with HIV was also shown to significantly decrease the time on the KT waitlist for PWH [3]. These results, paired with safety and minimal risk of drug–drug interactions of current antiretroviral therapy, have led to a tremendous advancement in transplantation in the United States, with promise to safely expand the donor and recipient pool and promote equitable access to organ transplantation [2, 4]. In June 2025, Organ Procurement and Transplantation Network (OPTN) HIV policies were revised to align with federal regulatory updates and now allow for transplantation of kidneys, livers, and liver–kidneys outside of a research protocol [5].