June 03, 2015
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HIV-positive organ donors can expand transplant pool

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Research published in the American Journal of Transplantation suggests there may be nearly 400 HIV-positive deceased organ donors annually in the United States, which could have a major impact for those in need of a transplant.

The findings are significant because there are not enough organ donors in the United States to meet the needs of all of the patients who might benefit from lifesaving organ transplants,” Emily A. Blumberg, MD, professor in the division of infectious diseases at the Perelman School of Medicine, University of Pennsylvania, said in a press release.

Blumberg and colleagues reviewed the records of 578 HIV-positive patients who died in Philadelphia HIV clinics from January 2009 through June 2014 to determine if their organs were viable for donation. The mean age for those studied was 53 years; 68% were male, and 73% were African-American.

The researchers identified four to five potential HIV-infected donors (HIVDDs) in Philadelphia annually, who could yield two to three kidneys and approximately twice as many livers for transplantation. The investigators extrapolated these numbers nationwide and discovered that about 356 potential donors would yield 192 kidneys and 247 livers annually.

“Although there are no formal data on HIV status of individuals on the transplant waitlist, after consulting with the transplant centers in the region, we estimate there are 80 to 100 HIV-infected patients currently on the transplant waitlist in Philadelphia, with five to 10 transplanted annually,” the researchers wrote.

Using kidney and liver donor risk indexes, the researchers projected that those receiving HIVDD kidneys would have a 3-year graft survival rate of 69.8% compared with the median transplanted kidney in 2013 of 82.6%. The 3-year graft survival rate for liver recipients, however, was estimated to be similar for those with livers transplanted from HIVDDs (70.6%) vs. those with other transplantations (73.5%), according to Blumberg and colleagues. Advanced age, African-American race and high rates of diabetes and hypertension were associated with lower quality of liver and kidneys.

According to the investigators, the study offers hope for all patients in need of organ transplantation.

“Some of the patients waiting for organs are infected with HIV but never make it to transplant ... . HIV patients who undergo transplantation generally do well, so it is important to continue to look for ways to improve access to transplantation for them,” Blumberg said.

While it is illegal to transplant organs from an HIV-positive patient to an HIV-negative recipient, according to the HIV Organ Policy Equity Act, the availability of HIV-positive donors for recipients with HIV means that more non-HIV infected donor organs may be available for those who are not HIV infected. by David Jwanier

Disclosure: The researchers report no relevant financial disclosures.