Dr. Dorry Segev, left, and Dr. Christine Durand answer questions about the first ever HIV-positive liver transplant in the world during a news conference.
When a Connecticut woman who was HIV-positive died earlier this month, her family decided to donate her organs to others who needed them.
Doctors in Maryland announced Wednesday that they performed two landmark, successful surgeries with her kidney and liver — transplanting the organs to HIV-positive patients.
This is a big deal, because there continues to be an overall shortage of organs available for transplant, and people living with HIV have an increased risk of kidney and liver failure. Though HIV-positive organs will only go to recipients who have HIV, the ability to use these organs should help reduce the waiting time for all transplant candidates, HIV-positive or not, physicians say.
Dr. Dorry Segev, a transplant surgeon with the Johns Hopkins University School of Medicine, led the team that performed the surgery, and says that he and colleagues first started talking about doing such a procedure six years ago.
“It occurred to us that there are thousands of patients with HIV in need of kidney transplants, liver transplants, who were waiting on waiting lists and suffered high risks of dying while waiting for these organs,” says Segev. “And at the same time, we were throwing away organs from donors infected with HIV just because they were infected with HIV. These were potentially perfectly good organs for these patients.”
But back in 1988, a law had made it illegal for people with HIV to donate organs when they died.
“At that time, in the 1980s, this made sense,” Segev says, “because HIV/AIDS was deadly disease.” And medical accidents with HIV had made transplant teams skittish.
“The virus had been transmitted inadvertently in quite a number of patients with solid-organ transplants,” says Dr. Peter Stock, a transplant surgeon at the University of California, San Francisco.
Stock says there was another reason doctors were reluctant to use the virus-infected organs. In order for anyone’s body to adopt a new heart, liver or kidney as its own, the organ recipient must take certain drugs that suppress the immune system. But AIDS also suppresses the immune system, and surgeons worried that an organ transplant in someone infected with the AIDS virus might actually do more harm than good.
“It didn’t make sense,” Stock says. “We were afraid we would cause rapid progression of HIV to AIDS and death.”
But by the 1990s, better treatment allowed people with HIV to live a lot longer than they used to. And that also meant that a lot more of them needed organ transplants.
In a 2010 study, Stock and other scientists found that transplant recipients with HIV did about as well as recipients who were HIV-negative. By that point, doctors in South Africa — where nearly 20 percent of adults under age 50 have HIV — had started successfully transplanting HIV-positive organs.
In November 2013, President Obama reversed the 1980s legal ban on such transplants in the U.S. — with bipartisan support.
Segev, who conducted the U.S. surgeries earlier this month, says the time just seemed right to start doing the transplants at Hopkins.
First, his team had to come up with safety protocols and, among other things, get approval from the United Network for Organ Sharing and from an institutional review board to do the procedure.
“It all came together,” Segev says. “So, this was a six-year challenge that involved identifying a problem that affected our patients, doing the research to better understand that problem, taking that to the Hill, getting the bill passed.”
Now he and his colleagues are working to make sure that the two patients who got these organs stay healthy. One is already at home, the other recovering in the hospital. The doctors also are working with 30 other hospitals in the U.S. to get similar surgeries going across the country. Transplant candidates can still opt to wait for an HIV-negative organ if they prefer, Segev notes.
“We want to make sure,” he says, “that we don’t take people who have a relatively non-resistant form [of HIV] and then give them something from a donor who had pretty high-resistance patterns, thereby requiring them to make major changes to their regimen, and maybe even have an HIV that would be less easy to control.”
Because of that concern, the Hopkins transplant team is only accepting HIV-positive organs at this point from people whose virus strains match those of the recipients.
Many people with HIV are expected to opt for the shorter wait period that getting an HIV-positive organ may entail. And that should slightly shorten the wait period for all transplant candidates, Stock says. “Our waiting lists are off the charts,” he adds. “If you’re in the Bay Area and you’re waiting for a kidney for specific blood types, you’re waiting seven to eight years, so anything we can do to increase the organ supply is so important.”
If all works as planned, Segev estimates this new source of organs might be enough for an additional thousand transplants across the U.S. each year.
Members of the Johns Hopkins medical team announced the first successful HIV-positive liver transplant.
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