HIV infection not a barrier for kidney transplants between people living with HIV
New research from South Africa shows that HIV infection is not a barrier for kidney transplants between people living with HIV (PLHIV), making kidney transplantation from an HIV-positive donor an additional treatment option for PLHIV requiring renal-replacement therapy. An estimated eight to twenty-two percent of the people on HIV treatment in South Africa experience kidney failure, for people not on treatment this percentages is as high as 20 to 27 percent.
People living with HIV have a higher risk of common causes of kidney disease than people living without the virus. HIV can have a direct effect on the kidneys - a syndrome called HIV nephropathy - causing the kidneys to fail. In countries where HIV is more prominent, this means that more donors are needed, but also that many potential kidney donors are themselves infected with HIV, therefore increasing the donor pool.
People living with HIV and suffering from kidney failure in South Africa, did not have an alternative option for treatment, other than kidney transplant, as they had been denied access to dialysis until only eight years ago. Although PLHIV became eligible for dialysis after 2008, dialysis is still a very limited resource. Many patients with stage five chronic kidney disease, regardless of HIV status, do not qualify. Transplanting a kidney from an HIV positive donor to a patient living with HIV was always considered a risk. The main concerns were that the donated kidney may come with a different strain of HIV, which could make the donor-recipient sicker; or that the second strain is more resistant, making it more difficult to treat the patient.
In the South African study, 27 patients living with HIV received a kidney transplant from an HIV positive donor who had died. They found that the survival rate following a transplant between HIV-positive patients is only modestly lower than the survival rate for a transplant for someone who is not infected with the virus. For patients living with HIV, there is an 84 percent survival rate after surgery, and a 74 percent survival rate after five years, compared to 91 and 85 percent for people not infected with HIV in the same hospital. However, patients living with HIV were more likely to reject the donor organ than people living without HIV. Although this is likely to not be a complication specific to receiving an organ from a donor living with HIV, as shown in earlier research. There were also no significant increases in viral levels after the transplant.
Although this trial focused only on kidney transplants, doctors believe there is room to expand to other organ transplants, including heart and liver. The South African research team started with kidney transplants because of the high prevalence of kidney failure in comparison to heart and liver failure in PLHIV, and because kidney transplants are considered to be less complicated than heart or liver transplants.