According to research results that were recently published in the medical journal The Lancet Regional Health - Americas, scientists from Johns Hopkins Medicine and three other partner institutions believe that people with HIV who donate a kidney to another person living with HIV (PLWH) have a low risk of developing end-stage kidney disease (ESKD) or other kidney issues in the years that follow the donation.
When the HIV Organ Policy Equity (HOPE) Act was passed in 2013, it gave HIV-positive individuals the legal ability to donate their organs as part of authorized clinical research trials to other individuals living with the infection who need transplants. In March 2019, Johns Hopkins Medicine performed the first kidney transplant from a living donor to another person with HIV in the country under the HOPE Act. For the new study, Nina Martinez, the donor in that famous treatment, as well as the second and third PLWH in the country to get the procedure, were tracked for two to four years following the transplant to record and evaluate their long-term outcomes.
The HOPE in Action Consortium, a U.S. organization with about 30 transplant institutions authorized to do HIV-to-HIV deceased donor kidney and liver transplants, provided the setting for the study. Only a few of the centers are currently conducting living donor HIV-to-HIV kidney transplants, which are only permitted for study.
According to the researchers, the study was conducted to address worries that nephrectomy (the surgical removal of a kidney) would raise the risk of ESKD in living donors who have HIV. It is well recognized that PLWH is more likely to develop kidney illness from HIV infection, liver damage from antiretroviral treatments (medications used to control HIV), hypertension, and diabetes.
Karl Neumann, 52 at the time of donation, Reed Benedict, 47 at the time, and Martinez, 35 at the time of donation, all consented to be named in this work and are recognized as research authors. Following their nephrectomies, they underwent evaluations at HOPE in Action Consortium centers at three, six, and annual intervals for two to four years. Physical examinations, sample collection for lab testing, and interviews were all part of the visits. Interviews were also used to record any hospitalizations, medication changes, severe adverse effects generally, or three or more adverse effects specifically connected to nephrectomy.
All three donors' pre-transplant biopsies revealed no kidney disease. Each donor's pre-transplant nine-year risk of getting ESKD was also evaluated, and all of them had minimal risks.
The researchers utilized a routine blood test for determining the quantity of a waste substance called creatinine to evaluate renal function. Each donor's estimated glomerular filtration rate (eGFR), or the capacity of their remaining kidney to filter waste materials and fluids from the body as urine, was calculated from the amount of creatinine discovered.
All three donors saw a modest decline in their eGFR at the assessments done two, three, and four years after the gift. The authors of the study claim that these modifications were predicted, equivalent to post-transplant eGFR declines found in kidney donors who do not have HIV, and do not suggest that the donors in this study are developing a chronic renal disease or kidney failure. The authors further state that all nephrectomy-related side effects were easily treated when they manifested.
Hopefully, the favorable outcomes for these three HIV-positive Americans who donated kidneys may persuade additional HIV-positive Americans to think about living donation, adds Durand. Every year, hundreds of lives could be saved if there were more organs available for HIV-to-HIV transplants. This would benefit all patients waiting for transplants, regardless of their HIV status.
The lifelong risk of ESKD in PLWH who become living donors is yet unknown, according to Durand and her coworkers. They claim that to address this issue, larger research with longer follow-up times is required.
Knowing the value of organ donation, Martinez adds, "I was thrilled that the HOPE Act enabled me to become the first living donor with HIV in the country as well as a registered deceased donor." The issue that the donor's remaining kidney cannot function independently of the donated organ is being eliminated with the results of this study and hopefully those from future studies, according to the authors.
The study team is made up of Durand, the three kidney donors, and Johns Hopkins Medicine employees Fawaz Al Ammary, Willa Cochran, Derek Fine, Tao Liang, Abimereki Muzaale, and Aaron Tobian; Cameron Wolfe and Arthur Baker from the Duke University School of Medicine; Leah Goudy, Aneesha Shetty, Valentina Stosor, Michelle Callegari, Zachary Deitch, and others from the Feinberg School of Medicine at Northwestern University; From the New York University Grossman School of Medicine, Allan Massie and Dorry Segev; and Cheryl Winkler from the Frederick National Laboratories for Cancer Research of the National Cancer Institute.
The National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, supported the study under grant number U01AI134591.
Durand claims to be a member of a Gilead Sciences grant review committee. Segev declares working for Sanofi, Novartis, CSL Behring, Jazz Pharmaceuticals, Veloxis Pharmaceuticals, Mallinckrodt Pharmaceuticals, and Thermo Fisher Scientific as a consultant and earning honoraria for speaking engagements. Shetty claims to be a member of Veloxis Pharmaceuticals' advisory board.
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