People living with HIV can safely receive kidney transplants from donors who are also HIV-positive, according to a groundbreaking study published in the New England Journal of Medicine. The research, which analyzed 198 kidney transplants performed across the United States, found comparable outcomes whether the donated organ came from a person with or without HIV.
The study’s findings come as the U.S. government moves to expand the practice of using HIV-positive donor organs. Last month, the Department of Health and Human Services proposed a rule change that would allow these types of kidney and liver transplants outside of research studies. If approved, the rule could take effect in the coming year and apply to both living and deceased donors.
Participants in the study were HIV-positive individuals with kidney failure who agreed to receive an organ from either an HIV-positive or HIV-negative deceased donor, depending on availability. Researchers followed the recipients for up to four years, comparing those who received kidneys from HIV-positive donors to those who received organs from donors without HIV.
Results showed both groups had similar high rates of overall survival and low rates of organ rejection. While some patients experienced temporary increases in HIV viral load—13 patients in the HIV-positive donor group and four in the other group—these rises were mostly linked to inconsistent adherence to HIV medications. In all cases, virus levels returned to very low or undetectable levels.
“This demonstrates the safety and the fantastic outcomes that we’re seeing from these transplants,” said study co-author Dorry Segev of NYU Langone Health.
The practice of transplanting organs between HIV-positive individuals has its roots in South Africa. In 2010, surgeons provided the first evidence that using HIV-positive donor organs was safe in people with HIV. The United States lifted its ban on such transplants in 2013, initially allowing them only within research studies. In 2019, Segev and colleagues at Johns Hopkins University performed the world’s first kidney transplant from a living HIV-positive donor to an HIV-positive recipient.
To date, over 500 transplants of kidneys and livers from HIV-positive donors have been conducted in the United States. The recent study’s findings may encourage other countries to adopt similar practices. In an editorial accompanying the study, Elmi Muller of Stellenbosch University in South Africa predicted the research will have “far-reaching effects in many countries that do not perform transplantations with these organs.”
“Above all, we have taken yet another step toward fairness and equality for persons living with HIV,” wrote Muller, who pioneered the practice.
The introduction of HIV-positive organ transplants could significantly reduce wait times for all patients in need of kidneys, regardless of HIV status. As the medical community continues to address organ shortages globally, this development marks an important step toward more inclusive and effective transplant practices.
Reference(s):
New study shows kidney transplants safe between people with HIV
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