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Johns Hopkins announces first successful HIV-positive to HIV-positive organ transplants in US
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A multidisciplinary team from Johns Hopkins Medicine has successfully performed the first HIV-positive to HIV-positive kidney transplant in the United States, as well as the first HIV-positive to HIV-positive liver transplant worldwide, medical center representatives announced today during a press conference.
“This is a very exciting day for us to be able to transplant patients with HIV, but it’s really only the beginning,” Dorry L. Segev, MD, PhD, associate professor of surgery at Johns Hopkins University School of Medicine, said during the event. “We’re in the process of teaching transplant centers across the country the protocols that we’ve put together, sharing with them our experience and our safety measures and things that we’ve put into place so that patients can have the opportunity for these HIV-to-HIV transplants across the United States.”
Dorry L. Segev
These successful procedures are the product of multiyear collaborations between researchers, legislators, policy agencies and organ donor networks, Segev said, and stem from enactment of the HIV Organ Policy Equity (HOPE) Act of 2013.
“About 6 years ago, we were transplanting HIV-positive patients with HIV-negative organs, and they were doing very well,” Segev said during the conference. “It occurred to us that there are thousands of patients with HIV in need of [transplants] who were waiting on waiting lists and suffered high risks of dying. … At the same time, we were throwing away organs from donors infected with HIV just because they were infected with HIV. These were potentially perfectly good organs for these patients.”
Since the 1980s, organ transplantation involving donors with HIV were barred by U.S. legislation out of fear of new infections, Segev said. After conducting preliminary research — which found that 300 to 500 potential donors with HIV were dying each year at the cost of approximately 1,000 usable organs — Segev and colleagues petitioned Congress to revise the ban, eventually resulting in the HOPE Act’s passage.
“This opened the opportunity for [the Health Resources and Services Administration] and [the United Network for Organ Sharing] to change national policy to allow us to use these organs,” Segev said. “That policy took a couple of years to change so that we could make sure to do this as safely as possible, and we worked hand-in-hand with them to establish these.”
Christine Durand
Both recipients were patients living with HIV for more than 25 years and would not have been able to receive an uninfected organ expeditiously, Christine Durand, MD, assistant professor of medicine and oncology and an infectious disease specialist at Johns Hopkins, said during the conference. Each procedure was conducted without complications, and the patients are doing “extremely well,” she said; however, exposure to a new strain of HIV and the possibility of secondary infection will require further monitoring for present — and future — patients.
“We need to consider carefully whether the donors have resistant virus,” Durand said. “All of the recipients are going to be on HIV medications already, so when we consider these donors carefully and select them, we have to take into account matching regimens and matching HIV resistance patterns. This is something we’re going to monitor for carefully over the ensuing months.”
Carlos del Rio
News of the successful procedures was applauded by Carlos del Rio, MD, FIDSA, professor of medicine at Emory University School of Medicine and chair of HIVMA, who said that this announcement paves the way for other HIV patients currently waiting to receive a donor organ.
“For patients living with HIV, deceased donors with the same infection represent a unique source of organs holding the potential to save the lives of hundreds of HIV-infected patients struggling with liver and kidney failure each year,” del Rio said in a release. “We look forward to seeing this medical breakthrough offer hope to more people living with HIV infection who are in need of organ transplants.” – Dave Muoio
Disclosures: del Rio, Durand and Segev report no relevant financial disclosures.
Perspective
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Judith Aberg, MD, FIDSA, IDSA
There had been a reluctance to aggressively treat malignancies and other conditions requiring medications that further impair the immune system among persons with HIV. We now have many years of experience with HIV-infected persons living well post-organ and bone marrow transplant. Providing HIV-infected organs to those already infected with HIV will not only increase the access of available organs leading to improved outcomes of our patients, but will also enhance our knowledge on the safety of such procedures and understanding the potential consequences associated with transmission of different strain of HIV to someone already infected with HIV.
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