Transplants add hope for HIV patients
In a f irst that gives HIVinfected patients yet another chance for long lives, surgeons at Johns Hopkins University Medical Center have transplanted a kidney and a liver from a deceased donor who was positive for HIV into two HIV- positive recipients.
The transplant surgeries, which used organs donated by the family of a deceased HIV- positive woman, ended a 25- year stretch in which the organs of HIV- infected people willing to donate them were rejected for use in transplants.
The experimental procedure follows the 2013 enactment of the HIV Organ Policy Equity ( HOPE) Act, which repealed the ban on using such organs for transplantation.
“For these individuals, this could mean a new chance at life,” said Dr. Dorry Segev, the Johns Hopkins surgeon who performed the surgeries and pushed for ending the transplant prohi- bition.
Dr. Christine Durand, an infectious disease specialist at Hopkins who oversees the two transplant patients’ care, said the patients are doing well.
A patient who acquired a new kidney 30 years after contracting the HIV virus is home from the hospital, she said.
The second patient, who has been HIV- positive for 25 years, is “functioning extremely well” after receiving a new liver, which replaces one that failed due to com- plications of hepatitis C infection, Durand said.
Under the HOPE Act, only transplant recipients who are HIV- positive will be eligible to receive organs from HIV- positive donors. Still, the change is expected to make hundreds and potentially thousands of transplantable organs available each year to HIV- infected people with end- stage diseases of the kidneys, heart, liver or lungs.
Although the Hopkins surgeries involved the use of organs from deceased do- nors, experts expect that living HIV- positive donors will soon step forward to offer a kidney for transplantation. Segev said that many HIVinfected live donors are probably healthy enough to donate an organ without great risk to their health.
As other transplant centers join Hopkins in performing the procedures, the practice promises to shorten the line for all who await the call that a donor organ has become available.
The Organ Procurement and Transplantation Net- work’s waiting list has 121,220 patients, and another name is added every 10 minutes. Each day, an average of 22 patients die waiting for an organ.
Of the nearly 31,000 organ transplants performed annually in the United States, those involving organs from HIV- infected donors will remain a small minority: Experts estimate that each year, 500 to 600 HIV- positive people would die under circumstances that would make their organs available for transplant.
Dr. David Klassen, chief medical officer of the United Network for Organ Sharing, said that key questions remain about the new generation of transplants, which are conducted under rules that treat them as research procedures.
Among those are whether organs from HIVpositive donors will be as resilient as organs from uninfected donors.
Still, Klassen emphasized that the new procedures underscore how dramatically the prognosis for HIV- positive patients has changed.
“Certainly for years when HIV first came on the scene, it was a fatal illness: Everybody that got it died,” he said.
HIV- positive patients were not likely to get listed on the wait list because their prognoses were poor, and the thought of using HIV- infected organs would have been unthinkable, he said.
With the success of antiviral cocktails in treating HIV- infected people, “patients really have good prospects for long- term survival,” Klassen said.
Hopkins is the first transplant center to perform the experimental procedure, but two others — Hahnemann University Hospital in Philadelphia and Mt. Sinai Medical Center in New York — have also applied to perform such procedures as donor organs become available.