Kidney transplantation from an HIV‐positive cadaveric donor

Abstract

Kidney transplantation is the gold‐standard therapy for select HIV‐positive patients with ESRD. Since the Italian Ministry of Health defined the guidelines for organ donation from HIV‐positive persons in 2018, we report the first case of renal transplantation from an HIV‐positive cadaveric donor in two HIV‐positive recipients in Italy. The donor was a 50‐year‐old male, deceased due to post‐anoxic encephalopathy, with a history of HIV infection in HAART, undetectable viral load, and HCV‐related chronic hepatitis that had been previously treated. The first recipient was a 59‐year‐old female with a prior history of drug addiction, and she suffered from ESRD secondary to HIV nephropathy. The patient followed preoperative HAART with a good viral response and undetectable HIV viral load. She also had a history of HCV‐related chronic hepatitis that had been successfully treated. The right kidney was uneventfully transplanted. The patient developed an asymptomatic reinfection of endogenous BK virus. The second recipient was a 41‐year‐old male with ESRD secondary to polycystic kidney disease. The patient was HIV‐positive in HAART, with a good viro‐immunologic response and an undetectable HIV viral load. He suffered from a severe form of hemophilia A and HCV‐related chronic hepatitis, which had been previously treated with undetectable HCV RNA. The left kidney was uneventfully transplanted. At the end of follow‐up, both patients had a healthy condition with stable renal function, a persistently good viral response and undetectable HIV and HCV viral loads. These encouraging preliminary results seem to confirm the safety and effectiveness of kidney transplantation from select HIV‐positive donors.

Kidney transplantation from an HIV-positive deceased donor to an HIV-positive recipient

“…We herein report the first case of HIV-positive donor to HIV-positive recipient kidney transplantation in Denmark. This case corroborates findings from previous studies showing that kidney transplantation from carefully selected HIV-infected donors to carefully selected HIV-infected recipients seems to be a safe and effective treatment option 5 6 8 9 11 12…”

“…To address this challenge in HIV-infected patients, utilisation of HIV-positive donors for HIV-positive recipients (HIV D+/R+) was pioneered in South Africa in 20084 and has since encouraged several transplant centres to use HIV-positive donors with reports of excellent patient and graft survival as well as virological control 4–10…”

“…Major concerns regarding use of HIV-positive donors for this population are additional risk of transmission of a different (and possibly resistant) strain of HIV, loss of virological control and risk of other donor-derived infections. Nevertheless, based on the recently published experiences with promising outcome,4–10 it seems reasonable to consider this option for carefully selected HIV-positive patients with ESRD. We herein report the first case of kidney transplantation from an HIV-positive deceased donor to an HIV-positive recipient in Denmark.…”

Increasing the Donor Pool: Organ Transplantation from Donors with HIV to Recipients with HIV

“…The HOPE in Action trials will be able to provide transplant outcomes linked to true HIV donor status (49). Outside South Africa, a small handful of successful HIV D+/R+ transplants have been reported internationally (50)(51)(52)(53)(54).…”