Virus World

For the first time in Southern California, surgeons at UC San Diego Health have transplanted the kidney of a deceased donor with HIV into a recipient with a pre-existing HIV infection. The procedure is part of an unprecedented multi-site national clinical trial.

 

The procedure occurred earlier this month. The patient is expected to make a full recovery. In 2013, Congress passed the HIV Organ Policy Equity (HOPE) Act, an effort to alleviate a chronic shortage of donor organs, which hits patients with HIV particularly hard, resulting in extremely long wait times and a greater likelihood of dying before a donor organ becomes available. Though organ transplants between donors and recipients with HIV have been successfully conducted in South Africa since 2008, such transplants were illegal in the U.S. until passage of the HOPE Act, which permits transplants of kidneys and livers from donors with HIV to qualified recipients with well-controlled HIV and end-stage organ failure, under approved research protocols. The kidney clinical trial launched last year. The transplantation of organs from donors with HIV to recipients without HIV remains prohibited.

 

The shortage of donor organs is universal and persistent, with more than 113,000 Americans currently needing a transplant (with almost 75,000 on active waiting lists), according to the United Network for Organ Sharing. The kidney was the first human organ to be successfully transplanted in 1954 and is, by far, the organ most often transplanted. The use of donor organs infected with HIV or hepatitis B and C viruses has become more viable in recent years. In 2016, Saima Aslam, MBBS, associate professor of medicine at UC San Diego School of Medicine and director of the Solid Organ Transplant Infectious Diseases Service at UC San Diego Health, and colleagues in the organ transplant programs launched a clinical practice protocol to use organs from donors actively infected with the hepatitis C virus, which is now curable. The change has resulted in a significant expansion of the organ donor pool and a reduction in wait list time. Persons with HIV are at higher risk of requiring a kidney (or liver) transplant due to organ damage caused by the virus and by common, associated co-infections and conditions, such as hepatitis B and C, hypertension and diabetes.

 

UC San Diego is also participating in a second, similar clinical trial involving HIV-to-HIV liver transplants. That first-ever trial launched earlier this year at UC San Diego; it is actively recruiting patients as well.