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Organ Transplants From People with HIV or Hepatitis C Show Early Success

Kidney and liver transplants from HIV-positive donors have saved dozens of lives across the United States. The safety and effectiveness of these transplants are so high that doctors are beginning to use kidneys from donors with hepatitis C (HCV) which also show encouraging results.

Doctors at Johns Hopkins performed the first kidney and liver transplants from HIV-positive donors in 2016. Since then, 24 transplant centers participating in the HOPE in Action study have transplanted 14 kidneys and 10 livers from deceased HIV-positive donors to HIV-positive recipients.

As of early 2018, there were 115,096 individuals on the transplant waiting list in the U.S. New donor sources are needed to address the organ shortage crisis, and “the use of organs from donors infected with hepatitis C or HIV can be used for transplant under research protocols to save lives,” said Christine Durand, one of the principal investigators of the study and assistant professor of medicine at Johns Hopkins University.

“The HOPE in Action Pilot Trial provides encouraging early data that persons living with HIV in need of kidney or liver transplants can receive organs from HIV-infected donors and expect good outcomes,” added Durand.

Over three years, researchers will track the health of 160 HIV-positive kidney recipients to assess whether transplants from HIV-positive donors differ substantially from HIV-negative donor transplants. None of these life-saving surgeries would have been possible prior to 2013, when President Barack Obama signed the HOPE (HIV Organ Policy Equity) Act to end the national ban on organ transplants from HIV-positive donors.

The opioid epidemic in the U.S. generated an increase in overdose deaths and, as a consequence, a spike in the number of donor kidneys in young, otherwise healthy individuals with hepatitis C. In the past decade, over half of viable kidneys from such donors have been discarded – compared to less than 20% discarded from HCV-negative individuals.

In early results, Durand’s team has found that transplanting kidneys from HCV-positive donors to HCV-negative recipients does not result in chronic hepatitis C infection in recipients taking HCV antiviral prophylaxis. The first ten patients to receive this procedure experienced no adverse events related to prophylaxis and, moreover, benefited from an unusually short median wait time of 30 days.

“By continuing to expand the donor pool, we should be able to shorten wait times, and shorten the wait list,” said Durand.

Future trials by HOPE in Action will look at the safety and effectiveness of transplanting other organs – including heart and lung – from HIV-positive and HCV-positive donors. In the meantime, Durand offered a heartening message for people living with HIV or HCV:

“I hope that the people who hear about this study, who are also living with HIV or HCV, know they can make a decision to register as an organ donor. For people waiting on an organ transplant right now, I hope our studies bring them hope that they could receive a transplant, and have more donors that could help them.”

The rate of end stage kidney and liver disease is increasing in people with HIV, and previous research shows excellent transplant outcomes for these individuals. Increasing the pool of potential organ donors will help address the need for kidney and liver transplants in people regardless of HIV status. Innovative research across the U.S. is laying the groundwork to make this transplant strategy widely available in the future.