Pioneering the HIV-to-HIV organ transplant

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Being HIV-positive can lead to organ failure over time, time that many patients can’t afford to wait. Up until recently, there was little or no chance these folks could get an organ transplant.

Reynaldo Garza is finally building a healthy future after eight and a half years in limbo. Not only was he suffering from kidney failure, but being HIV-positive all but guaranteed he couldn’t get a transplant.

“They would give a good organ to another person that’s not HIV," he said. "Because back then, if you’re HIV, you were considered a high-risk.”

Reynaldo’s luck began to improve when transplant Dr. Peter Stock figured, why not let HIV-positive donors give up their organs when called upon by HIV-positive recipients?

“Patients no longer progressed from having HIV to AIDS," said Stock, a surgeon. "We’re seeing this increasing number of patients that need transplants with HIV. We know that the patients who have HIV don’t do as well on the waiting list.”

So, Stock and his colleagues led the move to reverse both federal and state laws banning such operations.

“I was like sign me up,” Reynaldo said.

Reynaldo wasn’t worried about the risks.

”At that point, I was just so tired of doing dialysis that I was willing to do anything to get an organ transplant,” he said.

So, after nearly nine years waiting for a kidney, Reynaldo was one of the first in California to receive an HIV-to-HIV transplant.

“It’s totally changed my life,” he said.

“The prognosis is as good as HIV-negative patients,” Stock said.

“I just saw the doctors," Reynaldo said. "'Just keep up the good work,' they said.”

HIV patients typically now have to wait about a year before being eligible for a transplant. Right now, there are 25 hospitals across the country that participate in the HIV-to-HIV donor program, including John Hopkins, Yale and Mt. Sinai.

RESEARCH SUMMARY
HIV ORGAN TRANSPLANTS FINALLY!
REPORT #2589

BACKGROUND: At this moment, more than 123,000 people in the United States are waiting for an organ. One more person is added to the national waiting list every 12 minutes. Each of these people is in desperate need of a kidney, liver, heart, or other organ. More than 6,500 people a year, about 21 a day, die before that organ ever becomes available. Organ donors are always in short supply in the U.S. There are far more people in need of a transplant than there are people willing to donate an organ. Most of the organs that are available come from deceased donors. When you fill out an organ donor card with your driver's license, you're agreeing to donate all or some of your organs if you die. A smaller number of organs come from healthy people. More than 6,000 transplants from living donors are performed each year.
(Source: https://www.webmd.com/a-to-z-guides/organ-transplant-donor-information#1)

FIRST HIV-POSITIVE TRANSPLANTS: After receiving approval from the United Network for Organ Sharing to be the first hospital in the United States to perform HIV-positive to HIV-positive organ transplants, Johns Hopkins did just that, becoming the first in the world to execute an HIV-positive to HIV-positive liver transplant and the first in the United States to do an HIV-positive to HIV-positive kidney transplant. A multidisciplinary team from Johns Hopkins Medicine jumped at the opportunity to perform the surgeries as soon as suitable organs and recipients became available. There are approximately 122,000 people on the transplant waiting list in the United States at any given time. Thousands die each year, many of whom might have lived had they gotten the organ they needed. With the passage of the HIV Organ Policy Equity Act of 2013 and the recent approval from the United Network for Organ Sharing, HIV-positive patients could have a second chance at life.
(Source: https://www.hopkinsmedicine.org/transplant/news_events/hiv-positive-to-hiv-positive-transplants.html)

RESEARCH CONTINUES: A large-scale clinical trial launched by the National Institutes of Health could pave the way for more HIV-positive patients with kidney disease to receive life-saving transplants. The trial, called the HOPE in Action Multicenter Kidney Study, will assess the risks of transplanting kidneys from HIV-positive donors into patients living with the virus, says Dr. Christine Durand, assistant professor of medicine at Johns Hopkins University and a principal investigator of the study. "We have an organ shortage crisis in this country and individuals living with HIV are disproportionately affected," she says. The research will help determine whether the pool of HIV-infected organs is "safe and effective." There are 468,000 Americans receiving dialysis for end-stage renal disease. According to Durand's research, an estimated 1.5 percent of those live with HIV. "This means that more than 10,000 HIV positive individuals could benefit from a kidney or liver transplant," says Durand. The HOPE in Action study will track 160 kidney transplants, half receiving HIV-positive kidneys and half receiving virus-free organs. Recipients will be monitored after surgery for signs of organ rejection, organ failure, and other complications, such as the risk of infecting the patient with more than one strain of HIV.
(Source: https://www.npr.org/sections/health-shots/2018/06/01/615860200/researchers-want-to-show-hiv-positive-organ-donation-is-safe-and-can-save-lives)