NIH study demonstrates safety of kidney transplantation between HIV+ donors, recipients
A study supported by the National Institutes of Health found similar outcomes for patients with HIV who underwent transplantation with an HIV+ or HIV– kidney, suggesting infected and uninfected organs have comparable safety profiles.
“HIV-positive (HIV+) individuals have a higher incidence of end-stage renal disease and face nearly (threefold) higher mortality on dialysis compared to their HIV-negative (HIV–) counterparts,” Christine M. Durand, MD, of Johns Hopkins University in Baltimore, and colleagues wrote. “Deceased donor kidney transplantation (DDKT) provides a substantial survival benefit to HIV+ individuals with ESRD, but a shortage of donors and decreased access to DDKT for HIV+ candidates remains a major challenge. As organ transplantation among HIV+ recipients continues to grow, novel donor sources are needed to address this disparity.”
According to the researchers, transplanting kidneys from HIV+ donors into HIV+ recipients was first performed in South Africa in 2008. While outcomes have been “encouraging,” Durand and colleagues caution against generalizing these results to other countries, primarily due to the higher prevalence of antiretroviral resistance and varying immunosuppression practices in the United States. Both of these, they wrote, “may lead to inferior transplant outcomes ... and increase rejection risk.”
Seeking to directly compare outcomes following transplantation with an HIV+ or HIV– kidney, the researchers assessed 75 transplants performed at 14 centers between 2016 and 2019 (25 with an HIV+ kidney).
All participants were followed for a median of 1.7 years, with no deaths occurring.
The researchers observed no differences in 1-year graft survival (91% survival with HIV+ kidney vs. 92% in HIV–), eGFR (63 mL/min/1.73m2 vs. 57 mL/min/1.73m2), HIV breakthrough (4% vs. 6%), infectious hospitalizations (28% vs. 26%) or opportunistic injections (16% vs. 12%).
Durand and colleagues noted that while overall outcomes were “excellent” when using HIV+ kidneys for transplantation, allograft rejection appeared to be more common in patients who received an infected kidney and in those who did not receive lymphocyte-depleting induction. This led the researchers to recommend further investigation be conducted to determine the optimal immunosuppression for this patient population.
Despite this uncertain area, Durand and colleagues expressed optimism about their findings, concluding, “This unique donor organ source has the potential to mitigate disparities for a vulnerable population that faces lower access to transplant and higher waitlist mortality.”