People living with HIV who require a kidney transplant can be reassured by new research indicating that outcomes are comparable whether the kidney donor is also HIV-positive or HIV-negative. The study, published in the New England Journal of Medicine, found no significant differences in survival rates or serious side effects between the two groups.
The research team, led by Dr. Dorry Segev, vice chair of surgery at NYU Grossman School of Medicine, tracked outcomes from 198 kidney transplantations involving people with HIV across 26 U.S. medical centers between 2018 and 2021. Ninety-nine of the kidney donors were HIV-positive, while the other 99 were not.
Key Findings
The study revealed that one-year survival rates were 94% for recipients of organs from HIV-positive donors and 95% for those from HIV-negative donors. Three-year survival rates were also similar, at 85% and 87%, respectively. Organ rejection rates after three years were 21% and 24% for the two groups, respectively. Surgical complications and side effects showed few differences.
Notably, 13 of the 99 organ recipients who received a kidney from an HIV-positive donor experienced a temporary increase in HIV levels in their blood. However, this was attributed to inconsistent adherence to HIV-suppressing medications, and levels returned to normal once patients resumed their drug regimens. Only one case of HIV superinfection occurred, and it did not affect the patient's health.
Implications for Clinical Practice
Dr. Segev stated that the study provides "clear evidence for moving kidney transplantation in people with HIV from the experimental phase to standard clinical practice and updating guidelines accordingly." This shift could significantly benefit the approximately 90,000 people on the kidney transplant waitlist in the United States, as individuals with HIV are twice as likely to die while waiting for a transplant.
The U.S. Department of Health and Human Services has already proposed policy changes to standardize HIV-to-HIV transplantation for both kidney and liver donors, signaling a move towards broader acceptance of this practice. The HOPE Act, passed by Congress in 2013, has supported research into the safety of HIV-positive to HIV-positive organ donation.
