More hospitals perform transplants for HIV-positive patients

Life expectancy after HIV diagnosis is 32 years

Topics: Surgery, Service Lines

October 15, 2012

The number of hospitals offering vital organ transplant procedures to HIV-positive patients nearly doubled from 2005 to 2011, in part because of enhanced drug therapies that have improved life expectancy.

According to United Network for Organ Sharing, the number of centers that said they performed an organ transplant for an HIV-positive patient increased from 25 of the nation's 242 transplant centers in 2005 to 48 centers in 2011.

Altogether, at least 198 HIV-positive patients received an organ transplant in 2011, up from 58 in 2005. However, the actual number of transplants may be higher because not all states allow hospitals to share information about a patient's HIV status.

To date, most of the transplants for HIV patients involve kidneys and livers, but a handful of medical centers have begun to transplant hearts as well.

Improved drug regimen, life expectancy drives transplant trend

While it is illegal for an HIV-positive to donate an organ, even to other HIV-positive patients, no law has barred HIV-positive patients from receiving implants.

Still, physicians have historically avoided transplanting donated organs into HIV-positive patients—some hospital protocols even banned it altogether—largely because of such patients' lower life expectancy and concerns that the drugs they took could damage an organ.

But improved antiretroviral drugs adopted in 1996 helped reduce patients' viral loads to near undetectable levels arrived, and life expectancy after diagnosis has since jumped to an estimated 32.1 years, the Journal reports.

"There are so many patients who are [HIV-positive] but are in good shape and look better than other patients that we transplant," says Hiroo Takayama, a surgeon at Columbia University Medical Center.

For some researchers, concerns remain

However, researchers continue to express concern about the long-term outcomes of transplants into HIV-positive patients, particularly in the case of heart transplants.

For example, one study found that HIV-positive patients suffer about as much aortic inflammation as patients with cardiovascular disease. In addition, an NIH-sponsored trial found that the kidney rejection rate in HIV-positive patients was two to three times higher than other patients. While medicines can help control rejections, "each episode takes life out of the kidney," says study investigator Peter Stock of the UC-San Francisco School of Medicine. That may result in differences in survival with non-infected patients ten years down the road, Stock says (Marcus, Journal, 10/11).

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