Hopkins begins nation's first HIV-positive organ transplants
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| Doctor Dorry Segev answers questions about the first ever HIV-positive liver transplant in the world during a news conference at Johns Hopkins hospital, March 30, 2016 in Baltimore. 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. |
WASHINGTON
(AP) -- Surgeons in Baltimore for the first time have transplanted
organs between an HIV-positive donor and HIV-positive recipients, 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. Hopkins
didn't identify its patients, but said the kidney recipient is
recuperating at home and the liver recipient is expected to be
discharged soon.
"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 already have the AIDS virus, nothing changes - they wouldn't be offered HIV-positive organs.
Instead, the surgeries, performed earlier this month, are part of research to determine if HIV-to-HIV transplants really help.
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 the 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 hospital given permission for HIV-to-HIV transplant research. Two
others - Hahnemann University Hospital in Philadelphia and Mount Sinai
Medical Center in New York - also are approved for studies, according to
the UNOS.
Segev helped spur a 2013 law - the
HIV Organ Policy Equity, or HOPE, Act - that lifted a federal ban on any
use of HIV-infected organs and paved the way for that research.
UNOS
says at least 1,376 people with HIV have undergone transplants using
HIV-negative organs since 2005. Special expertise is required to
coordinate both the anti-HIV medications and anti-rejection drugs those
patients require, but large studies have shown that HIV patients fare
well after transplant.
Using an HIV-positive
organ adds an extra concern: Transplant recipients are exposed to a
second strain of the virus from the donor, explained Dr. Christine
Durand, a Hopkins infectious disease specialist. Doctors have to
consider what anti-AIDS medications the donor took to avoid introducing
HIV drug resistance.
Hopkins' first HIV-to-HIV
transplants were possible thanks to a deceased donor. The New England
Organ Bank, which arranged for that donation, issued a statement from
the unidentified woman's family expressing gratitude that someone who
fought HIV's stigma was able to donate and help others.
But Segev said his team also is exploring how to safely attempt kidney transplants using living donors who have HIV.
And advocates said it's time for more people to ask about becoming organ donors.
"If
you have considered donation but think that no one would want your
organs, let the doctors decide that," said Morris Murray, an
HIV-positive Maryland man who waited years before receiving an
HIV-negative liver transplant in 2013.
