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First living donor HIV-to-HIV kidney transplant performed at Johns Hopkins University

By Surgical Tribune
April 04, 2019

BALTIMORE, U.S.: For the first time, a person living with HIV has donated a kidney to a transplant recipient who is also HIV-positive. A multidisciplinary team from Johns Hopkins University School of Medicine recently completed the living donor HIV-to-HIV kidney transplant. This significant achievement could mean that many HIV-positive people will be helped with an organ donation in the future.

“This is the first time someone living with HIV has been allowed to donate a kidney, ever, in the world, and that’s huge,” said Dr. Dorry Segev, Professor of Surgery at the university. “A disease that was a death sentence in the 1980s has become one so well controlled that those living with HIV can now save lives with kidney donation—that’s incredible.”

People living with HIV have not been able to donate kidneys until now, because there were worries that HIV was too much of a risk factor for kidney disease in the donor. However, Segev and colleagues’ recent research on over 40,000 people living with HIV showed that the new antiretroviral drugs are safe for the kidney, and that those with well-controlled HIV have basically the same risks as those without HIV and are healthy enough to donate kidneys. The study, titled “Risk of end-stage renal disease in HIV-positive potential live kidney donors,” was published in the July 2017 issue of the American Journal of Transplantation.

“What’s meaningful about the first living kidney donor who is also living with HIV is that this advances medicine while defeating stigma, too. It challenges providers and the public to see HIV differently,” said Dr. Christine Durand, Associate Professor of Medicine at the university. “As patients waiting for a transplant see that we’re working with as many donors as possible to save as many lives as possible, we’re giving them hope. Every successful transplant shortens the waitlist for all patients, no matter their HIV status.”

Durand and Segev are leading HOPE in Action, an effort that encompasses multiple national studies exploring the feasibility, safety and effectiveness of HIV-to-HIV transplantation. Segev helped draft the HIV Organ Policy Equity (HOPE) Act, which was passed in November 2013 and now allows transplantation of organs from HIV-positive living and deceased donors to HIV-positive individuals with end-stage organ disease in the U.S. Nina Martinez, the 35-year-old kidney donor living with HIV, first learned of the HOPE Act at the time of its passage in 2013. She lives in Atlanta and is a public health consultant, clinical research volunteer and policy advocate dedicated to eliminating the stigma still surrounding HIV.

“Some people believe that people living with HIV are sick, or look unwell,” said Martinez. “For me, I knew I was in good health. HIV was no longer a legal barrier to organ donation and I never considered HIV to be a medical barrier either. As a policy advocate, I want people to change what they believe they know about HIV. I don’t want to be anyone’s hero. I want to be someone’s example, someone’s reason to consider donating.”

After corresponding with Segev about the possibility of donating, Martinez traveled to Baltimore in October 2018 to undergo an evaluation for potential kidney donation at the Johns Hopkins Hospital. The tests required multiple trips for analysis to be certain that she was healthy enough to donate, which is standard in evaluating potential living kidney donors.

“Other people living with HIV before me participated in clinical research so that I could not just survive but thrive. It was my turn to do this,” said Martinez.

During their evaluation, the surgical team confirmed Martinez had healthy kidneys and a low viral load, which met criteria required by the HOPE federal safeguards. Once cleared, she successfully donated a kidney to a recipient who wishes to remain anonymous.

According to the United Network for Organ Sharing, about 113,000 people are on the transplant waiting list in the U.S. as of March 2019; the longest is for a kidney. Approximately 20 Americans die each day waiting for transplants. People living with HIV who volunteer to be living donors could potentially save the lives of thousands of HIV-positive people in need of transplants each year.

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