Patients living with HIV who received kidney transplants from donors with HIV had high rates of overall survival and kidney graft survival after 5 years, with no evidence of sustained superinfection, according to study findings from South Africa, which pioneered HIV-to-HIV kidney transplants just over a decade ago.
The survival rates were on par with 3-year rates seen in the United States among HIV-positive patients who received organs from HIV-negative donors, researchers said.
“The study is a follow-up publication investigating some of the virological issues in patients who receive a kidney from an HIV-positive donor. The reason for doing it is that we already know the clinical outcomes of the patients who receive this are good, but we don’t know if there is a risk in giving a patient a second viral strain,” Elmi Muller, MD, PhD, of the University of Cape Town, told Infectious Disease News. “This study addresses some of the safety issues and more long-term outcomes (10 years).”
Muller and colleagues followed all 51 HIV-positive kidney transplant recipients who received organs from HIV-positive donors going back to 2008. They tested 15 donors and 26 recipients for the presence of antiretroviral drugs, HIV drug–resistant mutations, evidence of viral inoculum from the donor and sustained donor-derived HIV superinfection.
According to the report, eight patients died from non-graft–related causes after transplantation, though patient survival was 87% 1 year and 3 years after transplantation and 84% at 5 years. The percentage of patients who did not experience graft rejection was 75% at 1 year, 61% at 3 years, and 56% at 5 years, Muller and colleagues reported. The authors said that although drug-resistant mutations were found in samples from six recipients, none were donor derived and none of the recipients changed their ART regiment due to virologic failure. One case of “transient” superinfection was determined to likely be a result of residual virus carried over from the donor and not a true superinfection.
“We are showing that it is possible to see some donor virus in recipients early after the transplant, but that a sustained superinfection is unlikely. This means that the new viral strain has little clinical risk in patients who receive organs from HIV-positive donors,” Muller said. “HIV positive-to-positive transplant remains a safe procedure to provide much-needed organs from a donor pool that had previously been untapped.” – by Caitlyn Stulpin
Disclosures: Muller reports no relevant financial disclosures.