The world's first! Successful living kidney transplantation for AIDS patients

Thirty years ago, being infected with HIV meant being sentenced to death. Now, they can not only live healthy, but also save lives. On March 25, 2019, the Johns Hopkins University School of Medicine completed a live kidney transplant from an HIV-infected person to an HIV-infected person. According to Dorry Segev, a professor of surgery at Johns Hopkins University School of Medicine, this is the first case in the world to allow HIV-infected people to donate kidneys.

Christine Durand, MD, a member of the Johns Hopkins University's Sinikinmeer Comprehensive Cancer Center, believes that this case promotes medical advancement on the one hand, and it also forces health workers and the public to change their perceptions of HIV on the other hand. We are working hard to work with as many donors as possible to save as many lives as possible."

Kidney transplantation between HIV patients

The HIV-infected person who donated the kidney was named Nina Martinez. When she was a baby, she was infected with HIV because of blood transfusion, which made her feel the strange vision of others. However, Martinez did not regard herself as a patient. "For me, I know that I am healthy," she said. In fact, many HIV-positive patients are now able to achieve a healthy life due to advances in antiretroviral therapy.

Donor Nina Martinez. Image source: AFP

As a public health consultant, in 2013, Martinez was informed of the passage of the HIV Organ Policy Equity Act, which allows organ transplants between HIV-positive patients, ending up to 25 years. A ban on organ donation to HIV-infected people.

In July 2018, Martinez learned that a friend who was also infected with HIV needed to transplant the kidneys. Martinez felt that he needed help. She then went to Johns Hopkins Hospital for an assessment of potential kidney donations to ensure her health status met the donation requirements.

Unfortunately, her friend did not even wait until the end of the evaluation to die. However, Martinez decided to donate the kidney to an anonymous recipient. After a series of assessments to ensure that Martinez had a healthy kidney and a low viral load, Martinez completed the donation process. "She is in very good health and her HIV control is very good. Her immune system is basically normal," said Christine Durand, an associate professor of Johns Hopkins Hospital and responsible for health assessment.

Martinez and surgeon Segev. Image source: Johns Hopkins Medicine

At present, according to doctors, Martinez and organ recipients who have completed organ transplants are in good condition. In the future, Martinez and organ recipients will still need to continue to use antiretroviral drugs indefinitely to control HIV levels in the body. At the same time, because the virus strains in the two patients may not be the same, doctors need to observe the two closely in the next few months.

Transplantation procedure. Image source: Associated Press

At one time, people were very worried that the donation of organs by HIV-infected people would have an impact on their health and could lead to a high risk of kidney disease for donors. In 2017, researchers at Johns Hopkins Hospital led a study of 42,000 people. The results showed that healthy HIV-positive organ donors were no more likely to have severe kidney disease than HIV-negative people.

In 2018, an article in the American Journal of Organ Transplantation showed that HIV-controlled infections may meet the health requirements of organ donation as long as there is no history of diabetes, uncontrolled hypertension, or proteinuria. “Many people think that I and people like me can bring death,” Martinez said in an interview with the media before the operation. “But donating organs is a good way to tell the society that we can save lives. ”

"Now, AIDS patients can't donate blood, but they can already donate their kidneys," Dorry Segev said. "Thirty years ago, HIV infection meant death, but now they are healthy and can save lives."

Non-live HIV transplantation in the past

Since 2008, Elmi Muller, a transplant surgeon at the University of Cape Town, South Africa, has started a kidney transplant between HIV-positive patients. By the end of 2013, he had operated 26 cases of such surgery, but these cases were not living transplants. "I don't think there are too many choices for these patients, and there are not too many losses," Muller said. In South Africa, about 20% of the population is infected with HIV, and HIV patients who need new kidneys can't even have dialysis, let alone kidney transplants. HIV patients in South Africa usually do not live long before antiretroviral drugs are widely used.

Of the 26 kidney transplants performed by Muller, only 2 failed, and as Muller said, the benefits of surgery outweighed the possible risks. However, Muller also stressed that more research on safety and efficacy is still needed. For example, she mentioned that although the organ is basically healthy, because the donor is an AIDS patient, the virus may cause changes in kidney structure, but she does not understand whether the change is harmful.

In 2013, the United States passed the HIV Organ Policy Equity Act, and the United States has carried out surgery to transplant organs from deceased AIDS patients to other AIDS patients. According to the Washington Post, from 2016 to the present, it has been carried out. 116 such organ transplants. According to David Klassen, chief medical officer of the United Network for Organ Sharing, he was worried that organ recipients would be at risk because they were exposed to different strains, but no organ recipients have been found so far. Security risk issues.

“There may be thousands of AIDS patients who can donate their kidneys now,” Segev said, and he also suggested that other hospitals consider this approach. Overall, the donors donated by living donors are better than the kidneys of the donors. For example, Niraj Desai, a doctor at the Johns Hopkins Hospital who is responsible for organ recipients, believes that kidneys from living donors may survive longer.

For patients waiting for organ transplants, every day of waiting is a torment. When AIDS patients can become living organ donors, not only those who need organs, but also all those who are anxiously waiting for organs will be more Hope.