Early data find HIV patients do well with organ transplants
Researchers reported at the International Congress of the Transplantation Society in Miami in August that patients with HIV are successfully receiving liver and kidney transplants, challenging widespread reluctance by transplant centres to give scarce organs to people with incurable disease.
Because thousands of HIV patients are living longer with antiretroviral drugs, some develop organ failure for other reasons, making them candidates for transplants.
In the USA more than 80,000 people are now waiting for transplants, and more than 6,000 die each year waiting. While livers and kidneys are typically given to the sickest patients waiting, doctors will not give organs to anyone who is too sick to benefit. In many places, that means anyone with HIV. Just four or five hospitals offer organs to HIV-positive patients.
Pittsburgh-based researchers warned that HIV-positive patients require special attention after transplant because drugs taken to prevent the body from rejecting the new organ can worsen HIV. It is important to achieve the right balance between the medicines, they said.
The data presented were taken from several US transplant centres and one in France that offer kidneys and livers to HIV-positive patients. Some of the patients were given lower-quality organs or organs from donors at risk of HIV – one way to bypass others on the waiting list who may be pickier. Other patients received kidneys or partial livers from living family or friends. Still others came to the top of the waiting list the same way other transplant patients do.
A year or so after their transplants, HIV-positive patients are just as likely to survive as any other transplant recipients, researchers said. Specifically:
- In San Francisco, 13 of 14 liver and kidney recipients are alive, reported doctors from the University of California-San Francisco. There is no evidence HIV has advanced in any of the recipients.
- In Philadelphia, 17 of 20 kidney recipients are alive a year after their transplants. None of the three deaths was related to HIV.
- In Pittsburgh, two of seven liver recipients died and all four kidney recipients are alive, several months to five years after the transplants. — In Miami, all six liver recipients are alive, one to three years after transplants.
Associated Press, August 30, 2002