According to a recent study, it is just as secure and effective for individuals with HIV who require a kidney transplant to receive kidneys from HIV-positive donors as it is to receive them from donors who are not infected with the virus. The survival rates for organ recipients at one year and three years after transplantation were comparable for both donor groups.
This study represents the largest comparative trial since the first kidney transplant in the United States involving HIV-positive donors in 2016. Researchers from NYU Langone Health believe that their findings strongly support the idea of integrating the use of organs from HIV-positive donors into standard medical practice for patients with HIV who need kidney transplants.
In response to a global shortage of organ donors, the U.S. Congress enacted the HIV Organ Policy Equity Act, also known as the HOPE Act, in 2013. This legislation initiated research to assess the safety of kidney donations from HIV-positive individuals to those who also have the virus. Nearly 90,000 individuals in the U.S. are currently waiting for kidney transplants, and those who are HIV-positive are over twice as likely to die while on the waiting list compared to their HIV-negative counterparts.
Despite the promising findings, HIV-to-HIV transplantation has yet to be widely recognized as a standard practice. Initially, there were concerns that organ recipients could become infected with different strains of HIV, potentially leading to a phenomenon known as HIV superinfection. Experts also worried that the immunosuppression required after transplantation might harm the donated organ or worsen the recipient’s HIV viral load. A key issue in transplantation is that the recipient’s immune system might see the new organ as foreign and attempt to reject it, akin to fighting off an invading virus. To prevent rejection, transplant recipients are prescribed immune-suppressing medications. Fortunately, early successes in HIV-to-HIV kidney transplants have helped reduce these concerns.
Published online in the New England Journal of Medicine on October 17, researchers examined the outcomes of 198 kidney transplants performed on HIV-positive recipients at 26 medical centers in the United States between 2018 and 2021.
The results revealed that survival rates at one year for recipients who received kidneys from 99 HIV-positive donors and 99 HIV-negative donors were nearly identical (94% and 95%). Similarly, the three-year survival rates were close (85% for HIV-positive donors and 87% for HIV-negative donors), and the rates of organ rejection after three years were also comparable (21% and 24%). Other aspects of surgical outcomes, including the occurrence of side effects, were consistent across both donor groups.
While the majority of study participants were able to keep their HIV viral loads low after the transplant, 13 recipients of kidneys from HIV-positive donors experienced spikes in their HIV blood counts, compared to just four instances among those receiving organs from HIV-negative donors. Researchers linked these spikes to poor adherence to antiviral medication regimens, with viral suppression returning as patients followed their treatment more closely. Only one superinfection was noted, which did not affect the health of the recipient.
“Our study provides strong evidence that kidney transplantation from HIV-positive donors to recipients who are also HIV-positive is both safe and effective,” stated Dorry Segev, MD, PhD, the senior author and a transplant surgeon. Segev serves as the vice chair of the Department of Surgery at NYU Grossman School of Medicine and directs the Center for Surgical and Transplant Applied Research (C-STAR). He also played a crucial role in drafting the HOPE Act and has been a persistent advocate for its implementation, having conducted the first HIV-to-HIV kidney transplant at Johns Hopkins, his previous institution.
“Thanks to the HOPE Act and this NIH-funded multicenter trial, our findings provide compelling evidence to transition kidney transplantation for those with HIV from experimental to standard clinical practice, necessitating updates to existing guidelines,” said Segev, who also holds professorships in both the Departments of Surgery and Population Health at NYU Grossman.
“These results spark hope for countless individuals with HIV in the U.S. and globally who are in urgent need of kidney transplants, as well as for many others in regions where both HIV and kidney disease are prevalent,” Segev added.
In September, the U.S. Department of Health and Human Services proposed changes to establish HIV-to-HIV transplantation as standard care for kidney and liver donors.
According to Segev, further studies are essential to evaluate the safety and effectiveness of transplanting other organs, like the heart and lungs, from HIV-positive donors.
The study was funded by various National Institutes of Health grants, including R01AI120938, R01DK131926, U01AI134591, U01AI138897, U01AI177211, and R01DK101677.
