Investigators are hopeful that efforts including the recently passed HIV Organ Policy Equity Act, or HOPE Act, will provide expanded access to organs for HIV-positive patients and reduce the current U.S. organ shortage.
“What we know is that individuals in need of kidney transplants are most likely to find living donors from within their own social network, and for HIV-positive patients in need of a kidney transplant, this likely means they will identify potential living donors who are also HIV-positive,” said Jayme Locke, M.D., associate professor in UAB’s Department of Surgery and the study’s lead author. “The HOPE Act now makes it legal for HIV-positive people to donate to HIV-positive recipients, but no HIV-positive person has ever been a living donor. We know HIV-positive persons are at higher risk for kidney disease, and so there is some hesitation in the transplant community to allow HIV-positive persons to be living kidney donors in much the same way we discourage diabetic patients from being living kidney donors. In order to begin safely extending the practice of living donation to HIV-positive persons, we must continue to study risk in otherwise healthy HIV-positive non-donor populations in an effort to identify a subset of HIV-positive persons healthy enough to be living kidney donors. These efforts are the subject of ongoing research by our Comprehensive Transplant Institute Outcomes Research Group here at UAB.”
UAB transplant surgeons completed the Deep South’s first HIV-positive to HIV-positive transplant in November 2016, which made UAB hospital only the fourth hospital in the country to achieve a deceased donor HIV-positive to HIV-positive transplant — a significant feat for those living with the disease. If living HIV-positive donation could be possible, it would be another noteworthy advancement for millions with HIV.
More than 30 percent of the 1.2 million individuals in the United States living with HIV have kidney disease and are at increased risk of developing kidney failure. Also, HIV-positive patients with kidney failure are 19 times more likely to die on dialysis compared with uninfected kidney failure patients, and kidney transplantation lowers their risk of premature death by 79 percent compared with remaining on dialysis.
To examine HIV-positive patients’ access to kidney transplantation, Locke and her colleagues analyzed information from the Scientific Registry of Transplant Recipients compiled between 2001 and 2012, which includes data on all donors, waitlisted candidates and transplant recipients in the United States. Their study included 1,636 HIV-positive and 72,297 HIV-negative kidney transplant candidates on the waiting list.
The team found that, overall, HIV-positive patients were 28 percent less likely to receive a transplant compared with their HIV-negative counterparts, and they were half as likely to receive a kidney from a living donor.
|“While we understand little is known about the risks HIV-positive persons may incur from donating a kidney, we do see this study as the foundation for demonstrating the significance and need for identifying a subset of HIV-positive persons who are both willing and healthy enough to be living kidney donors such that HIV-positive to HIV-positive living kidney transplantation can be done safely and effectively.”|
“The supply of deceased donor organs remains limited, and as such, living kidney donors have become a critical source of organs,” Locke said. “While we understand little is known about the risks HIV-positive persons may incur from donating a kidney, we do see this study as the foundation for demonstrating the significance and need for identifying a subset of HIV-positive persons who are both willing and healthy enough to be living kidney donors such that HIV-positive to HIV-positive living kidney transplantation can be done safely and effectively.”
In an accompanying editorial, Sindhu Chandran, M.D., and Peter Stock, M.D., Ph.D., of the University of California, San Francisco, noted that the risks of receiving an HIV-positive kidney need to be balanced against the moral imperative to provide lifesaving organs to patients. “Data from transplants conducted within the framework of the HOPE Act will increase knowledge about the safety and efficacy of HIV-positive to HIV-positive kidney transplants in the United States, including possibly from living donors, and help define the future role of this strategy in improving equity and redressing disparities in transplantation for HIV-positive patients,” they wrote.
Study co-authors from UAB include Shikha Mehta, M.D., Deirdre Sawinski, M.D., Sally Gustafson, Brittany Shelton, Rhiannon Reed, Paul MacLennan, Ph.D., Charlotte Bolch, Christine Durand, M.D., Allan Massie, Ph.D., Roslyn Mannon, M.D., Robert Gaston, M.D., Michael Saag, M.D., Turner Overton, M.D., and Dorry Segev, M.D., Ph.D.
The article, titled “Access to Kidney Transplantation among HIV-infected Waitlist Candidates,” will appear online on Feb. 23, doi: 10.2215/CJN.07460716.
The editorial, titled “Opportunities and Challenges for Kidney Donation From and to HIV Positive Individuals,” will appear online on Feb. 23.