IFor people with HIV who need a kidney transplant, receiving an organ from a donor who is also HIV-positive is as safe and effective as getting one from a donor who is uninfected with the virus, new research shows. It was shown in Survival rates for organ recipients at 1 and 3 years after surgery were similar for donors with and without HIV infection. So was the risk of serious side effects such as infection, fever, and rejection in the donated organ.
In the study, which is the largest comparative trial of experimental procedures since the first transplant was performed in the United States in 2016, researchers at NYU Langone Health believe that the use of organs from people infected with HIV This provides further support for the formal adoption of this as standard clinical practice. People with HIV who require a kidney transplant.
Spurred by the global organ donor shortage, the U.S. Congress passed the HIV Organ Policy Equity Act (HOPE Act) in 2013, providing a recipe for kidney donors who are infected with HIV to test positive as well. paves the way for initial efforts to learn if it can be safely provided to patients. virus. Nearly 90,000 Americans are on waiting lists for kidney transplants, and HIV-positive people in need of a kidney transplant are more than twice as likely to die while waiting than HIV-negative people. are.
HIV-to-HIV transplantation is not officially recognized as a standard of care. There were concerns that organ recipients could become infected with other HIV strains, causing so-called HIV co-infection. Experts also initially worried that the recipient's need to continue post-surgery immunosuppression could damage the donated organ and help the recipient's HIV blood cell count recover. Ta. A serious problem with all transplants is that the recipient's immune system recognizes the donated organ as “foreign” and attacks it like it would an invading virus. For this reason, immunosuppressive drugs are used to prevent rejection of organ transplants. However, the early success of HIV-to-HIV kidney transplants has alleviated these concerns.
In the research, Published in of New England Medical Journal October 16th onlineResearchers analyzed the results of 198 kidney transplants to people infected with HIV performed at 26 medical centers across the United States from 2018 to 2021.
As a result, kidney transplants performed using organs from 99 HIV-infected and 99 HIV-uninfected donors had the same one-year survival rate for HIV-positive recipients. (94% and 95%, respectively). Three-year survival rates were similar (85 percent and 87 percent). Organ rejection rates were also numerically similar after 3 years (21 percent and 24 percent). Other measures of surgical outcome were also similar in both groups, including the number of side effects that occurred.
Although most of the kidney recipients in this study maintained viral suppression of HIV after transplantation, 13 patients who received kidneys from HIV-infected donors had rapid increases in their HIV blood cell counts. Only four such recurrence spikes occurred in organs from HIV-negative donors. However, the researchers believed that these outbreaks were due to recipients not taking their antiviral drugs as prescribed, and that tighter compliance with drug treatment restored viral suppression. One coinfection was detected, but there was no clinical impact on organ recipients.
“Our study overwhelmingly shows that kidney transplants from HIV-positive donors to HIV-positive recipients are safe and effective,” said study senior investigator and transplant surgeon Dolly L.・Segev, MD, said: Dr. Segev surgery Professor and Director of New York University Grossman School of Medicine Center for Applied Surgery and Transplantation Research (C-STAR). Dr. Segev also helped draft the HOPE Act and advocated for its passage. His team also performed the first HIV-on-HIV kidney transplant at Johns Hopkins University, where he previously worked.
“Thanks to this multicenter trial funded by the HOPE Act and the NIH, our research will move kidney transplantation in people with HIV from the experimental stage to standard clinical practice and update guidelines accordingly. We provided clear evidence,” Dr. Segev said. professor of surgery population health.
“These findings offer hope to the thousands of people living with HIV in the United States and around the world who need kidney transplants, and to many more in areas where HIV infection and kidney disease are more common.” Dr. Segev said.
The U.S. Department of Health and Human Services proposed in September: policy change Make HIV-to-HIV transplants the standard of care for both kidney and liver donors.
Dr. Segev says more research is needed to determine the safety and effectiveness of transplanting other organs, such as hearts and lungs, from HIV-positive donors.
Funding for this research was provided by National Institutes of Health grants R01AI120938, R01DK131926, U01AI134591, U01AI138897, U01AI1772111, and R01DK101677.
Dr. Segev has served as a consultant to pharmaceutical and healthcare companies AstraZeneca, CareDx, Moderna Therapeutics, Novavax, and Regeneron, as well as Springer Publishing, AstraZeneca, CareDx, Houston Methodist, Northwell Health, Optum Health Education, Sanofi, and WebMD. None of these groups were involved in the current study. The terms and conditions of all these relationships are governed by the policies and procedures of NYU Langone Health.
In addition to Dr. Segev, New York University researchers involved in this study include Sapna Mehta, MD; Dr. Alan B. Massey. Other researchers involved in this study are co-principal investigator Christine Durand, MD; Co-researcher Dr. Tao Liang. Diane Brown, BSN. Dr. Darin Ostrander. Yolanda Eby, Mississippi. Niraz Jesai, MD; Fiza Naqvi, Maryland. Selina Bagnasco, MD; Andrew Redd, Ph.D.; co-senior investigator Aaron Tobian, M.D., Johns Hopkins School of Medicine in Baltimore; Other study collaborators are Sander Frohman, MD, and Meenakshi Rana, MD, of the Icahn School of Medicine at Mount Sinai in New York City. Rachel Friedman Moraco, MD, Emory University, Atlanta; Alexander Gilbert, MD, Georgetown University, Washington, DC; Peter Stock, MD, University of California, San Francisco; Shikha Mehta, MD, University of Alabama at Birmingham; Dr. Valentina Stozer of Northwestern University in Chicago; Marcus Pereira, MD, MPH, Columbia University in New York City. Michelle Morris, MD, University of Miami; Jonathan Hand, MD, Ochsner Health in New Orleans; Saima Aslam, MD, MS, University of California, San Diego. Maricar Marinas, MD, Yale University, New Haven, CT; Gadi Haider, MD, University of Pittsburgh; Katherine Small, MD, Weill Cornell Medical College, New York City; Carlos Santos, MD, MPH, Rush University in Chicago. Joanna Schoenman, MD, University of California, Los Angeles; John Baddeley, MD, University of Maryland, Baltimore; David Wojciechowski, DO, University of Texas Southwestern at Dallas. Emily Blumberg, MD, University of Pennsylvania, Philadelphia; Karthik Ranganna, MD, Drexel University, Philadelphia; Dr. Oluwafisayo Adebiyi of Indiana University in Indianapolis; Dr. Nehel Elias of Massachusetts General Hospital in Boston. Jose Castillo-Lugo, MD, at Methodist Health System in Dallas. Emmanouille Georgakis, MD, at the University of Arkansas at Little Rock. Senu Apwokin, MD, University of Cincinnati; Natasha Watson, BSN, MD; Dr. Erica Brittain. Johan Odim, MD. at the National Institutes of Health in Bethesda, Maryland.
Media inquiries
david march
212-404-3528
[email protected]
