A new study finds that HIV-infected individuals with kidney failure are less likely to receive a kidney transplant—especially from living donors—than their uninfected counterparts. The study appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).
Jayme Locke, MD, MPH, FACS, from the University of Alabama at Birmingham, and her colleagues analyzed 2001 to 2012 information from the Scientific Registry of Transplant Recipients, which includes data on all donors, waitlisted candidates, and transplant recipients in the United States. Their study included 1,636 HIV+ and 72,297 HIV- kidney transplant candidates on the transplant waiting list.
The team found that, overall, HIV+ patients were 28% less likely to receive a transplant compared with their HIV- counterparts, and they were half as likely to receive a kidney from a living donor.
“The supply of deceased donor organs remains limited, and as such, living kidney donors have become a critical source of organs,” said Locke.
“While the recent HOPE Act permits HIV+ individuals to serve as living kidney donors for HIV+ patients, no HIV+ person has ever been a living kidney donor, likely because little is known about risks HIV+ persons may incur from donating a kidney. We see this study as the foundation for demonstrating the significance/need for identifying a subset of HIV+ persons who are both willing and healthy enough to be living kidney donors such that HIV+ to HIV+ living kidney transplantation can be done safely and effectively.”
In an accompanying editorial, Sindhu Chandran, MD and Peter Stock, MD, PhD, from the University of California, San Francisco, noted that the risks of receiving an HIV+ kidney need to be balanced against the moral imperative to provide lifesaving organs to patients.
“Data from transplants conducted within the framework of the HOPE Act will increase knowledge about the safety and efficacy of HIV+ to HIV+ kidney transplants in the US, including possibly from living donors, and help define the future role of this strategy in improving equity and redressing disparities in transplantation for HIV+ patients,” they wrote.
Study co-authors include Shikha Mehta, MD, Deirdre Sawinski, MD, Sally Gustafson, MS, Brittany Shelton, MPH, Rhiannon Reed, MPH, Paul MacLennan, PhD, Charlotte Bolch, Christine Durand, MD, Allan Massie, PhD, Roslyn Mannon, MD, Robert Gaston, MD, Michael Saag, MD, Turner Overton, MD, and Dorry Segev, MD PhD.