WASHINGTON/MIAMI – Surgeons in the U.S. for the first time have transplanted organs between an HIV-positive donor and HIV-positive recipients. It’s a long-awaited new option for patients with the AIDS virus whose kidneys or livers also are failing.
Johns Hopkins University announced Wednesday that both recipients are recovering well after one received a kidney and the other a liver from a deceased donor — organs that ordinarily would have been thrown away because of the HIV infection.
Doctors in South Africa have reported successfully transplanting HIV-positive kidneys, but Hopkins said the HIV-positive liver transplant is the first worldwide.
“This could mean a new chance at life,” said Dr. Dorry Segev, a Hopkins transplant specialist who pushed for legislation lifting a 25-year U.S. ban on the approach and estimates that hundreds of HIV-positive patients may benefit.
For patients who don’t have the AIDS virus, nothing changes — they wouldn’t be offered HIV-positive organs.
The surgeries, performed earlier this month, are part of research to determine if HIV-positive transplants really can help HIV-positive recipients.
The reason: Modern anti-AIDS medications have turned HIV from a quick killer into a chronic disease, meaning patients may live long enough to suffer organ failure, either because of their HIV or for some other reason.
In the U.S., HIV-positive patients already are eligible to receive transplants from HIV-negative donors just like anyone else on the waiting list.
That list is long — for kidneys, more than 100,000 people are in line — and thousands die waiting each year. There’s no count of how many of those waiting have HIV, but Segev said it increases the risk of death while waiting.
If the new approach works, one hope is that it could free up space on the waiting list as HIV-positive patients take advantage of organs available only to them. Segev estimated that 300 to 500 would-be donors who are HIV-positive die each year, potentially enough kidneys and livers for 1,000 additional transplants.
“It increases the pool of potential organ donors and allows more people to be transplanted. That’s the advantage of this whole thing, but it is a research project so we are going to monitor it very carefully,” said Dr. David Klassen of the United Network for Organ Sharing, which oversees the nation’s transplant system.
Hopkins is the first transplant center given permission to study what’s being called HIV-positive to HIV-positive transplants. Two others — Hahnemann University Hospital in Philadelphia and Mount Sinai Medical Center in New York — also are approved for the research, according to the UNOS.
The world’s first liver transplant from a donor infected with HIV to an HIV-positive recipient comes three years after a U.S. ban on such operations was overturned.
The procedure involved a deceased donor whose liver was transplanted into a patient who had been infected with the virus that causes AIDS more than 20 years ago, said doctors at Johns Hopkins University.
The same donor also gave her kidney to another patient for transplant.
“A couple of weeks ago we performed the first HIV-to-HIV liver transplant in the world, and the first HIV-to-HIV kidney transplant in the United States,” Segev told a press conference.
“This is a very exciting day for us,” Segev added.
“But it is really only the beginning.”
Both patients — whose identities were not revealed — are recovering well from their operations, the medical team said.
The kidney transplant patient has already left the hospital.
The donor’s name was not released, but her family issued a statement describing her as a “very boisterous soul” who fought for justice.
“She was a daughter, a mother, an auntie, best friend and sister,” it said.
“She was able to leave this world helping those underdogs she fought so hard for.”
Under U.S. law, it was illegal to use an organ from a donor infected with HIV for transplant until Congress passed the HOPE Act, which U.S. President Barack Obama signed into law in 2013.
People with HIV have been able to get organs from HIV-negative donors, but due to the scarcity of organ donors, many of those waiting die before they can get a transplant.
About 122,000 people are on the transplant waiting list in the United States. Thousands of people die each year while they wait.
Segev said his research has shown that between 500 and 600 people with HIV — and with organs healthy enough for donation — die each year.
Now that their organs can be used for other people with HIV, some 1,000 lives may be saved annually, he said.
Still, the operations carry “unique risks,” said Christine Durand, assistant professor of medicine and oncology at Johns Hopkins Medicine.
These risks include the possibility of being exposed to a second strain of HIV from the donor.
Doctors must also consider whether the donor has a resistant strain of the virus, she said.
While Johns Hopkins was the first to carry out the procedure, Segev said dozens of hospitals in the United States have enough experience with negative-to-positive transplants to learn the intricacies of doing positive-to-positive surgeries.
The announcement of the two operations was applauded by advocacy groups, including the HIV Medicine Association.
“For patients living with HIV, deceased donors with the same infection represent a unique source of organs holding the potential to save the lives of hundreds of HIV-infected patients struggling with liver and kidney failure each year,” said a statement from HIVMA board chair Carlos del Rio.
“We look forward to seeing this medical breakthrough offer hope to more people living with HIV infection who are in need of organ transplants.”