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Patients with HIV can safely receive kidneys from deceased HIV-positive donors, with good five-year survival rates
Michael Carter, 2015-02-16 18:10:00
patients can safely receive kidneys from deceased HIV-infected donors, investigators
from South Africa report in the February 12th edition of the New England Journal of Medicine. Survival rates one, three and five years
after transplantation were comparable to those observed in HIV-negative kidney
transplant patients. HIV infection remained well controlled but infections were
an important cause of death and hospitalisation.
“Our study showed
that kidneys from HIV-positive deceased donors can be transplanted into
carefully selected HIV-positive recipients, with the expectation that outcome
would be similar to that observed in kidney transplantation programs involving
high-risk patients without HIV infection,” comment the investigators. An
accompanying editorial described the study’s outcomes as “impressive.”
antiretroviral therapy many HIV-positive patients now have a near normal life
expectancy. But even in the era of effective therapy, between 8% to 22% of HIV-positive
patients receiving treatment have chronic kidney disease.
suggests that HIV-positive individuals doing well on antiretroviral therapy can
have good outcomes and survival rates after kidney transplantation from
South Africa wanted to see if HIV-positive patients with end-stage kidney
disease could safely receive kidneys from deceased donors who were also
HIV-positive. The study was undertaken at the transplantation centre of the
Groote Schuur Hospital in Cape Town. The policy of providing HIV-infected
patients with kidneys from deceased HIV-positive individuals was initiated
because HIV infection was considered a contraindication for the receipt of a
donated organ. Although this policy changed in 2009, investigators continued to
provide HIV-positive patients with kidneys donated by HIV-positive patients who
had died. They monitored medium term
survival rates in 27 patients who received kidneys between 2008 and 2014.
They kidneys were
provided by 15 deceased individuals who were either HIV treatment naïve or
taking first-line antiretrovirals. None had an AIDS-defining opportunistic
infection or proteinuria.
To be eligible for
inclusion in the study, the recipients were required to have been taking a
stable antiretroviral regimen for at least three months with an undetectable
viral load and CD4 cell count of at least 200 cells/mm3. Follow-up
was for a median of 2.4 years.
experienced graft failure within the first two weeks of transplantation. But
the other 25 individuals had well-functioning replacement kidneys after one
year. Survival rates one, three and five years after transplantation were 84%,
84% and 75%, respectively. The graft survival rate was 95% at year one,
decreasing to 84% at years three and five. These outcomes were comparable to
those seen in HIV-negative patients who received donated kidneys at the same
There were eight
cases of graft rejection, six of which were reversed with appropriate
immunosuppressive therapy. Five patients died after transplantation. Infections
were the principal cause.
infection remains a major cause of complications and death in patients who have
received a transplant,” note the authors. There were also numerous
hospitalisations due to infections, but these were successfully treated.
Median CD4 cell
count decreased to a 179 cells/mm3 after one year of follow-up, a
decline the authors attributed to the use of immunosuppressive therapies.
However, there was then a slow increase with counts reaching a median of 386/mm3
after three years. All the patients maintained an undetectable viral load. This
shows that interactions between anti-HIV and immunosuppressive drugs can be
successfully managed. Moreover, it also suggests that the use of donated organs
from individuals with HIV does not involve a risk of superinfection with drug-resistant
strains of virus.
The authors of an
editorial that accompanies the study believe the findings go a long way to
allaying fears about the safety of using organs from deceased HIV-positive
donors in HIV-positive recipients. They conclude, “these transplantations now
appear to be not only feasible but also, in fact, desirable for many patients.”