March 29, 2019

Johns Hopkins surgeons perform first-ever live HIV-positive kidney transplant

Daily Briefing

    Surgeons at Johns Hopkins Medicine on Monday performed the first-ever kidney transplant from a living HIV-positive donor to an HIV-positive patient, potentially opening the door to an expanded pool of organ donors.

    Background

    Until recently, leaving an HIV-positive patient with just one kidney was thought to be too risky for potential donors, as the infection and the medications that control HIV increase the patient's risk of developing kidney disease.

    However, a 2017 study of 42,000 people showed that, for some HIV-positive kidney donors, the risk of developing serious kidney disease was not much higher than most HIV-negative people, including those who engaged in behaviors such as smoking, the Washington Post reports.

    In 2013, Congress passed the HIV Organ Policy Equity (HOPE) Act, which permitted organ transplants between HIV-positive patients in clinical trials and allowed the HHS secretary to sign off on transplants between HIV-positive patients.

    Since 2016, 116 kidney and liver transplants between deceased HIV-positive donors to HIV-positive recipients have taken place, according to the United Network for Organ Sharing, which oversees the transplant system. There are over 113,000 people on the waiting list for organ transplants in the United States, most seeking kidneys, according to the Associated Press. There is no indication of how many of those people are HIV-positive.

    A first-of-its-kind surgery

    Surgeons at Hopkins performed the transplant Monday, and the donor, 35-year-old Nina Martinez, and the recipient, who chose to remain anonymous, are both reportedly doing well. Johns Hopkins said Martinez was discharged from the hospital on Thursday while the recipient is in stable condition and will likely be discharged soon.

    According to Dorry Segev, a professor of surgery at the Johns Hopkins University School of Medicine, kidney recipients can expect about 20 to 40 years from a transplanted kidney, and those receiving a kidney from live donors tend to do better than those receiving them from deceased donors. When the transplant no longer functions, the recipient can expect to go on dialysis, according to the Post.

    With the transplant, the recipient will take drugs to prevent organ rejection. Those drugs are not expected to significantly interfere with medications that suppress HIV.

    Martinez has "near-normal physical health," the Post reports. Christine Durand, an associate professor of medicine at Hopkins and a member of the team that evaluated Martinez, said, "Her HIV is well-controlled. Her immune system is essentially normal."

    Doctors will closely monitor the recipient because Martinez and the recipient may have different strains of HIV and different resistance to HIV medication.

    Implications

    "This is the first time someone living with HIV has been allowed to donate a kidney, ever, in the world, and that's huge," Segev said. He added, "There are potentially tens of thousands of people living with HIV right now who could be living kidney donors."

    Separately, Niraj Desai, an assistant professor of surgery at Hopkins, noted the indirect benefits this could afford HIV-negative patients. "That's one less person waiting for a limited resource," he said. "That helps everybody on the list."

    Martinez said she wanted to donate her kidney to change the perception of people living with HIV. She had originally planned to donate a kidney to a friend with HIV, but the friend died before she could donate to him, according to the Post.

    "Society perceives me, and people like me, as people who bring death," she said. "And I can't figure out any better way to show that people like me can bring life" (Bernstein, Washington Post, 3/28; AP/Los Angeles Times, 3/28; Budryk, The Hill, 3/28; Knight/Rodriguez, Kaiser Health News, 3/28).

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