Trailblazing liver and kidney transplants from an HIV-positive donor to HIV-positive recipients were announced Wednesday by surgeons at Johns Hopkins University.
“A couple of weeks ago, we performed the first HIV-to-HIV liver transplant in the world and the first HIV-to-HIV kidney transplant in the United States,” Dr. Dorry Segev said during a midday media briefing.
Before 2013 and passage of the HIV Organ Policy Equity Act, this kind of medical advance would not have been possible, because it was illegal for HIV-positive patients to donate organs in the United States. The act allows HIV-positive donors to donate organs to patients infected with the AIDS-causing virus, Segev said.
Until the law was changed, thousands of patients with HIV in need of organ transplants often risked death while waiting for a donated organ, he said.
At the same time, “we were throwing away organs from donors infected with HIV just because they were infected. These were potentially good organs,” said Segev, a professor of surgery and director of the epidemiology research group in organ transplantation at the Baltimore-based medical school.
Dr. Christine Durand, an assistant professor of medicine and oncology at Hopkins, said the transplant operations went well and both patients are doing “extremely well.”
The patient who received the kidney has already gone home, and the liver transplant patient is expected to leave the hospital in a couple of weeks, she said.
Both the liver and kidney came from a deceased HIV-infected donor, the doctors said.
Now that HIV can be controlled with medications, there’s no reason why donor organs from HIV-positive people can’t be used for HIV-positive patients in need of transplants, Segev said.
According to Segev, approximately 122,000 people are on transplant waiting lists in the United States at any time. Each year, about 500 to 600 potential organ donors who are HIV-positive die, he said.
Segev said his team is now teaching transplant centers across the country “the protocols we put together and sharing our experience and safety measures.”
At the moment, these protocols only cover deceased donors, but Segev said he and his colleagues have started researching the possible use of organs from living HIV-positive donors.
“It’s a tremendous advancement that will help the HIV population,” said Dr. David Bernstein, chief of the division of hepatology at Northwell Health in Manhasset, N.Y., who was not involved in the transplants.
“This should open up transplantation to a significant segment of the population that has had a difficult time getting transplants,” he said.
HIV-positive patients aren’t restricted to getting organs from HIV-positive donors. They can opt to accept an organ from a non-HIV-infected donor, potentially cutting their waiting time for a transplant, Durand said.
Transplanting organs from HIV patients carries some risks, Durand said. “These patients will be exposed to a second strain of HIV from the donor and may be infected with that strain,” she said.
It’s important, therefore, to consider if the donor has drug-resistant HIV, she said. “All the recipients are on HIV medications already, so we have to take into account matching regimens of drugs,” she said.
In addition, it’s important to ensure that the immunosuppressant drugs needed to prevent rejection of the transplanted organ don’t interfere with the HIV drugs, Durand said.
“We are encouraged by these first transplants and now it is our hope and our aim to extend this possibility to other patients who are waiting on the transplant list,” she said.
To learn more about organ transplants, visit the United Network for Organ Sharing.
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