title: The feasibility of lung transplantation in HIV-seropositive patients.
abstract: BACKGROUND
  HIV seropositivity has long been considered a contraindication to lung transplantation, primarily because of the potential risks of added immunosuppression. In the past decade, however, experience with kidney and liver transplantation in the setting of HIV infection, with achievement of satisfactory outcomes, has grown considerably. This promising development has created a need to reconsider this contraindication to lung transplantation.
  
  
  OBJECTIVE
  There is presently limited evidence upon which to base medical decision-making regarding lung transplantation in individuals with HIV infection. In our present study, we wished to extend the existing literature by reporting the outcomes of three individuals with HIV infection who underwent lung transplantation at two centers.
  
  
  METHODS
  We compiled data for a case series of three HIV-infected subjects undergoing lung transplantation at two centers.
  
  
  RESULTS
  We reviewed medical records to investigate the effects of lung transplantation on the course of HIV infection, the development of HIV-related opportunistic infections or malignancies, the occurrence of lung transplant and HIV drug interactions, and the extent of acute rejection. Subject 1, who underwent transplantation for HIV-associated pulmonary arterial hypertension, experienced recalcitrant acute rejection requiring a lymphocyte-depleting agent with subsequent rapid development of bronchiolitis obliterans syndrome. Subjects 2 and 3, who underwent transplantation for idiopathic pulmonary fibrosis, experienced mild acute rejection but remain free from chronic rejection at 4 and 2 years after transplant, respectively.
  
  
  CONCLUSIONS
  Lung transplantation may be feasible for carefully selected patients in the setting of controlled HIV infection. On the basis of our experience with three patients, we caution that acute graft rejection may be more common in such patients.
authors: 1 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine.
authors: Ryan M
authors: RM
authors: Kern
authors: Harish
authors: H
authors: Seethamraju
authors: Paul D
authors: PD
authors: Blanc
authors: Niraj
authors: N
authors: Sinha
authors: Matthias
authors: M
authors: Loebe
authors: Jeff
authors: J
authors: Golden
authors: Jasleen
authors: J
authors: Kukreja
authors: Scott
authors: S
authors: Scheinin
authors: Steven
authors: S
authors: Hays
authors: Mary Ellen
authors: ME
authors: Kleinhenz
authors: Lorri
authors: L
authors: Leard
authors: Charles
authors: C
authors: Hoopes
authors: Jonathan P
authors: JP
authors: Singer
mesh_terms: D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000150:complications / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged
keywords: acute rejection; human immunodeficiency virus; idiopathic pulmonary fibrosis; lung transplantation; pulmonary arterial hypertension