Observational Study Results Suggest Most HIV–HIV Kidney Transplants Have Long-term Success

Following research highlighting a high prevalence of kidney disease among people living with HIV, a study published today in the New England Journal of Medicine is reporting encouraging results for those in need of a kidney transplant.

The study, which followed 51 people with HIV who received kidney transplants from deceased donors with HIV in South Africa, found that the transplants resulted in long-term success, with high rates of overall survival and kidney graft survival after 5 years.

Five years after receiving a kidney transplant, 83.3% of participants were still alive and 78.7% still had a functioning transplanted kidney. These findings are similar to those seen in a 2010 study in the United States funded by the National Institute of Allergy and Infectious Diseases (NIAID), which reported an 88.2% survival rate and a 73.7% kidney graft survival rate after 3 years.

“In South Africa, the United States, and elsewhere, a growing number of people with HIV have a need for kidney transplants. Unfortunately, these gifts of life are too often in short supply,” Anthony S. Fauci, MD, director of NIAID, said in a statement. “This observational study provides additional evidence that organs from donors with HIV could be a new donation source for people living with both HIV and end-stage renal disease.”

At the time of transplantation, all patients had achieved viral suppression, and the researchers noted that there were not observed increases in viral load among those who maintained consistent use of antiretroviral therapy following the transplant.

The donors, many of whom were not aware of their HIV status, had strains of HIV that were genetically distinct from those of the transplant recipients, according to the researchers. As a result, the researchers sequenced the virus genomes of the donor—recipient pairs and analyzed blood samples from recipients at multiple time points to determine if they developed HIV superinfection—the acquisition and establishment of a second genetically distinct strain of HIV in a person who is already infected.

Data was collected from transplants beginning in 2008, when South Africa began successfully accomplishing these transplants. These transplants were illegal in the United States until the HIV Organ Policy Equity Act took effect in 2013. The legislation allows US transplant teams with approved research protocols to transplant organs from deceased donors with HIV into qualified recipients with HIV and end-stage organ failure.

This current study was a collaboration between the NIAID and the University of Cape Town, South Africa.

“This collaboration leverages expertise in both of our countries to address an urgent common problem,” said Glenda Gray, MBBCH, FCPaed (SA), president and chief executive officer of the South African Medical Research Council, in a statement. “Our combined efforts have the power to make sure people with HIV experiencing organ failure are not exempt from longer, healthier lives that international HIV research has made possible.”