who received kidney transplants from deceased
donors in South Africa were the study participants, the research team followed,
and data from transplants beginning in 2008 were used for the study.
"In South Africa, the United States, and
elsewhere, a growing number of people with HIV have a need for kidney
transplants. Unfortunately, these gifts of life are too often in short supply,"
study provides additional evidence that organs from donors with HIV could be a
new donation source for people living with both HIV and end-stage renal disease. If these
findings are corroborated in ongoing clinical trials, we will have a chance to
improve the health of many people living with HIV and increase the overall
supply of transplantable organs,"
study was designed and performed by a research team from NIAID and a group of
physicians and scientists from the University of Cape Town who worked closely.
While all the kidney
and primary laboratory analyses took place in South
Africa, NIAID's Laboratory of Immunoregulation in Baltimore provided the
supplementary laboratory support.
the SAMRC President and Chief Executive Officer said, "This collaboration leverages expertise in both of our countries to
address an urgent common problem. Our combined efforts have the power to make
sure people with HIV experiencing organ failure are not exempt from longer,
healthier lives that international HIV research has made possible."
Findings of the Study
made by a research team from the University of Cape Town in this study were
similar to an earlier study from the U.S. While the South African study looked
at people living with HIV who received kidneys for
transplant from donors with HIV
, in the U.S. study the donors were
South African group, 83.3 percent survived and 78.7 percent continued to have a
functioning transplanted kidney. The findings from the 2010 NIAID-funded study
in the U.S. reported an overall survival rate of 88.2 percent and kidney
graft survival rate of 73.7 percent after three years.
At the time
of transplantation, all the participants from the South African group were
virally suppressed and the research team did not notice any increase in the
amount of virus (viral load) in those patients who had consistently used antiretroviral therapy (ART)
Many of the
deceased donors who were part of the study were unaware of their status, had
HIV strains that were genetically different from the transplant recipients.
Knowing this, the virus genomes of donor-recipient pairs were sequenced and
blood samples collected from the recipients were analyzed by the scientists to
note any occurrence of HIV superinfection, during multiple follow-up visits.
When a second genetically distinct strain of the virus gets acquired and
established in a person already living with HIV, the condition is referred to
as HIV superinfection.
HIV superinfection typically respond well to the standard ART and mostly do not
experience poor clinical outcomes as research shows. Nonetheless, the study
participants were closely observed for likely superinfections with strains of
HIV that might remain unaffected by a recipient's ART regimen as there are
certain strains that are resistant to some anti-HIV medications.
probable case of transient superinfection was identified by the scientists,
which was established to be a residual virus carried over from thee donor
following the transplant and not a genuine sustained superinfection. All
participants would be monitored continuously by the research team for signs of
superinfection. Though the ART regimen of 10 participants changed during the
study, none was due to drug resistance.
Significance of the Study
Muller of the Groote Schuur Hospital in Cape Town is the study's lead
scientist. Andrew D. Redd, of the NIAID Laboratory of Immunoregulation who is
the study author commented: "This work
builds on the groundbreaking research by Dr. Muller and her team in South
Africa beginning more than 10 years ago that opened the door to the exciting
field of organ transplantation between people with HIV around the world. By
using the most advanced laboratory techniques available, our team showed that
HIV superinfection is of limited risk in these patients. Taken together with
the positive long-term clinical outcomes we found in our study, we feel our
data strongly support the expanded use of these life-saving
said, "This project would not have been
possible without the combined effort of our South African and U.S. teams, which
demonstrates the power of truly collaborative international research."
HIV Organ Policy Equity (HOPE) Act
People living with HIV are at a higher risk of developing end-stage
kidney diseases and because of the impairment caused by the virus, common
coinfections and related comorbidities like hepatitis B
and C viruses, hypertension
, requiring organ transplantation.
can also result because of the toxicities caused by certain antiretroviral
As the health outcomes were expected to be worse, people
with HIV were hardly considered fit to receive organ transplants from HIV-negative donors, until recently.
passing of the HIV Organ Policy Equity (HOPE) Act of 2013, such transplants were
considered illegal. Considering the high incidence of HIV-related comorbidities
that would make organ transplantation necessary, the law intended to increase
organ availability for people with HIV.
The HOPE Act
allows U.S. transplant teams to retrieve organs from HIV donors and transplant
them to eligible people
with HIV, having end-stage organ failure, with
an approved research protocol. This practice may help reduce the wait time for
those requiring a transplant.
research supported by NIAID exhibited that the patient and organ graft survival
rates of those without HIV who receive transplants and people living with HIV
and organ failure (but otherwise healthy) receiving kidney or liver from
HIV-negative donor, could be the same if
the candidate is chosen carefully.
of this study offered the scientific basis for the early HIV-positive to
HIV-positive kidney transplants performed in South Africa and passing of the
HOPE Act of 2013.
trials, funded by the NIAID, are underway to assess the safety and
effectiveness of this practice at various transplantation centers in the U.S.
in Action Multicenter Kidney Study
(started in 2018) and the HOPE
in Action Multicenter Liver Study
(launched February 2019) will equate
clinical outcomes between people living with HIV who receive organs from
deceased donors with HIV and those who receive HIV-negative organs.
- Most Kidney Transplants Between People with HIV Have Long-Term Success - (https://www.niaid.nih.gov/news-events/most-kidney-transplants-between-people-hiv-have-long-term-success)