Kidney transplants from HIV-positive donors lifesaving for other HIV patients

A US government-backed study has shown that kidney transplants between HIV-positive donors and recipients are safe and effective. This could transform the treatment for those suffering from renal failure.

In Short

• Kidney transplants between HIV-positive donors and recipients are as safe
• A study showed similar survival rates between HIV-positive and HIV-negative kidney transplants
• This research could lead to life-saving kidney transplants for people with HIV, say experts

Kidney transplants between HIV-positive donors and recipients are safe and effective, offering new hope to those suffering from end-stage kidney disease.

The study was conducted by the Johns Hopkins University School of Medicine and funded by the US medical research agency National Institutes of Health (NIH).

Published in the New England Journal of Medicine, the study shows that transplant outcomes between HIV-positive individuals (HIV D+/R+) are comparable to those between HIV-negative donors and recipients (HIV D-/R+), marking a major milestone in the field of organ transplantation.

A CRITICAL LIFELINE FOR HIV PATIENTS

Kidney transplantation offers a significant survival advantage for people with HIV who suffer from end-stage kidney disease, yet the shortage of available organs poses a serious barrier to treatment.

Speaking about the breakthrough in kidney transplant in the study, Dr Suriraju V, Senior Consultant Urologist and Founder of Regal Hospital, who is not involved in the study, said that in India, where the demand for kidney transplants far exceeds the available donors, this discovery could be transformative.

"Each year, approximately 1.8 lakh people suffer from renal failure, yet only around 6,000 transplants are performed. This leaves a vast number of patients in a difficult position, many of them waiting for years or never receiving the life-saving organ they need," said Dr Suriraju.

Individuals with HIV face higher risks of death while on the organ waitlist and are often granted fewer opportunities for transplants compared to HIV-negative individuals.

To address this disparity, the HIV Organ Policy Equity (HOPE) Act was passed in 2015 in the US, legalising kidney transplants between donors and recipients with HIV.

Although this practice is currently restricted to research settings to ensure patient safety, the latest findings could pave the way for broader application.

"This study demonstrates that kidney transplants between HIV-positive donors and recipients can be as safe and effective as those from HIV-negative donors," said one of the lead researchers from Johns Hopkins University.

"These results could potentially lead to greater access to lifesaving organ transplants for people living with HIV," the researcher said.

STUDY FINDINGS

The study enrolled 198 adults with HIV and end-stage kidney disease from 26 different medical centers across the United States.

The outcomes of 99 participants who received kidneys from HIV-positive donors were compared with 99 who received organs from HIV-negative donors, monitored over three years.

Key metrics such as overall survival, graft survival (kidney function post-transplant), and rejection rates were similar between both groups.

One year after transplantation, the survival rate for HIV-positive recipients was 94% in the HIV-positive donor group and 95% in the HIV-negative donor group.

After three years, the survival rates were 85% for HIV-positive donors and 87% for HIV-negative donors. Graft survival was also similar, with a 93% survival rate after one year for those who received kidneys from HIV-positive donors and 90% for those with HIV-negative donors.

Notably, the risk of kidney rejection was slightly lower in the HIV-positive donor group, with rejection rates of 13% at both one and three years post-transplant compared to 21% in the HIV-negative donor group.

LIFESAVING TREATMENT

The results of the study suggest that kidney transplantation between HIV-positive individuals is both safe and non-inferior to the standard practice of using HIV-negative donors.

"Currently, the concept of HIV-positive organ donors is limited to research settings in many parts of the world, but with the success of studies like the NIH’s, I believe this could soon change. If properly regulated, India could benefit from this breakthrough, giving hope to thousands who remain on waitlist," said Dr Suriraju.