Kidney transplantation is safe for people with HIV, US study shows

People with HIV can safely receive donated kidneys from deceased donors infected with the virus, according to a large study conducted as the U.S. government tries to expand the practice. This could reduce waiting times for organs for everyone, regardless of HIV status.

A new study published Wednesday in the journal New England Journal of Medicinelooked at 198 kidney transplants performed in the United States. The researchers found similar results regardless of whether the organ donation came from a person with or without the AIDS virus.

Last month, the Department of Health and Human Services proposed a rule change that would allow these types of kidney and liver transplants to be performed outside of research studies. The final rule will apply to both living and deceased donors. If approved, it could come into effect next year.

Study participants were HIV-positive, had kidney failure, and agreed to receive an organ from either an HIV-positive deceased donor or an HIV-negative deceased donor, depending on which kidney became available first.

Similar survival rates

The researchers followed the organ recipients for four years. They compared half of the patients who received kidneys from HIV-positive donors with those whose kidneys came from donors without HIV.

Both groups had similarly high overall survival rates and low rates of organ rejection. Virus levels rose in 13 patients in the HIV donor group and four in the other group, largely due to the patients not taking their HIV medications consistently, and in all cases returned to very low or undetectable levels.

“This demonstrates the safety and fantastic results we are seeing from these grafts,” said study co-author Dr. Dorrie Segev of NYU Langone Health.

In 2010, surgeons in South Africa provided the first evidence that the use of HIV-positive donor organs is safe for people with HIV. But the practice was not legal in the United States until 2013, when the government, at Segev’s urging, lifted the ban and allowed scientific research. Initially, studies were conducted on deceased donors. Then, in 2019, Segev and others at Johns Hopkins University in Baltimore performed the world’s first kidney transplant from a living donor with HIV to an HIV-positive recipient.

In total, 500 kidney and liver transplants from HIV-positive donors have been performed in the United States.

“Win-win”

People with HIV are actively discouraged from becoming organ donors because of stigma and outdated state laws and policies that criminalize organ donation for people with HIV, says Carrie Foote, a sociology professor at Indiana University Indianapolis.

“Not only can we help those of us living with this disease, but we can also free up more organs from the entire organ pool so that those who do not have HIV can receive an organ more quickly,” said Foote, an HIV-positive person and registered organ donor. “It’s a win-win for everyone.”

More than 90,000 people are on the kidney transplant waiting list, according to the US Organ Procurement and Transplantation Network. In 2022, more than 4,000 people died waiting for kidneys.

In a journal editorial, Dr. Elmy Muller of the University of Stellenbosch in South Africa predicted that the new research would have “far-reaching implications in many countries where these organs are not transplanted.”

“Above all, we have taken another step toward justice and equality for people living with HIV,” wrote Mueller, who pioneered the practice.