South Africa: Kidneys Transplanted Between HIV-Infected Patients

A South African report of successful kidney transplants between HIV-positive donors and recipients is sparking renewed interest in offering such procedures in the United States.

The report describes four transplantations between September and November 2008. The recipients had end-stage renal disease, were receiving antiretroviral therapy, had an HIV viral load of less than 50 copies per milliliter for more than six months and, with the exception of one patient with fully treated tuberculosis, had no history of opportunistic infections.

The four transplanted kidneys were from two donors who had not received antiretroviral therapy, did not have a history of serious opportunistic infection or cancer and had normal renal biopsies.

In South Africa, dialysis and transplantation from an HIV-negative donor are not available to HIV-positive patients in the state sector, according to the physicians' report of the procedures.

As therapy extends the expected lifespan of HIV patients, they face complications such as anemia and kidney failure. The waiting list for a donor kidney in the United States is about eight years, and allowing someone who is HIV-positive to be a donor may shorten that time for recipients with HIV, said Dr. Peter Stock, a researcher at the University of California-San Francisco.

U.S. doctors already perform organ transplants between patients with hepatitis C, Stock noted.

Drug-resistant strains of HIV are more common in the United States than in South Africa. Such a transplant in the U.S. setting, therefore, might transmit to the recipient a strain of the virus more virulent than the one the patient already has.

The full report, "Renal Transplantation Between HIV-Positive Donors and Recipients," was published in the New England Journal of Medicine (2010:362(24):2336-2337).

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