Patients With HIV Have Low Risk of End-Stage Renal Disease After Donating Kidney

Patients with HIV can donate a kidney to other patients with HIV who have a low risk of developing end-stage renal disease (ESRD) or other kidney problems for 2 to 4 years following donation, according to the results of a study published in The Lancet Regional Health—Americas.^1,2

“This new evidence is proof-of-concept that donating a kidney can be safe for people living with HIV,” Christine Durand, MD, an associate professor of medicine at Johns Hopkins Medicine and medical director of the Johns Hopkins Transplant Research Center, said in a statement. “When added to the consistently positive outcomes documented for recipients of these organs, our study provides support that living donations from people with HIV to recipients with HIV can and do work.”¹

Under the HIV Organ Policy Equity (HOPE) Act, individuals with HIV can donate living kidneys in the United States, though there have been concerns that the donor could have an increased risk of ESRD. The study authors noted this could be due associated kidney disease as well as antiretroviral therapy (ART) nephrotoxicity.²

Investigators of the study included 3 donors with 2 to 4 years of follow-up: a female aged 35 years, a male aged 52 years, and a male aged 47 years from the HOPE in Action Multicenter Consortium. Before donation, they estimated a 9-year cumulative incidence of ESRD and performed genetic testing of apolipoprotein L1 (APOL1), excluding those with high-risk variants. Additionally, investigators performed pre-donation biopsies, which is a HOPE Act requirement.²

The primary endpoint was grade 3 or higher nephrectomy-related adverse events (AEs) in 1 year. After the donation, the investigators also monitored the glomerular filtration rate (GFR), HIV RNA, CD4 count, and ART.²

Investigators found that the 9-year estimated cumulative incidence of ESRD was 3.01, 8.01, and 7.76 per 10,000 individuals, estimated using the 35-year-old female, 52-year-old man, and 47-year-old man, respectively. Two donors with APOL1 testing did not have high-risk variants. All 3 donors did not demonstrate kidney disease, according to the study authors.²

Additionally, after donation, 2 donors had nephrectomy-related grade 3 or greater AEs, which included medically managed ileus and a laparoscopically repaired incisional hernia, according to the results of the study.² Investigators also found that the GFR declined from 103 ml to 84 mL/min/1.73 at 4 years for donor 1, from 77 ml to 52 mL/min/1.73 m2 at 3 years for donor 2, and 65 ml to 29 mL/min/1.73 m2 at 3 years for donor 3.Furthermore, all donors remained at less than 20 copies/mL of HIV RNA and had stable CD4 counts.²

The study authors said that these evaluations and follow-ups could provide additional options for transplantation, for both donors and recipients with HIV.²

“Hopefully, our findings demonstrating positive outcomes for these 3 [individuals] living with HIV who donated a kidney will encourage other Americans living with HIV to consider living donation,” Durand said in the statement. “Having more organs available for HIV-to-HIV transplants helps everyone waiting on a transplant, regardless of HIV status, and could save hundreds of lives each year.”¹

References

1. Study shows positive outcomes for first three U.S. living HIV-to-HIV kidney transplant donors. News release. EurekAlert. July 24, 2023. Accessed July 27, 2023. https://www.eurekalert.org/news-releases/996554
2. Durand CM, Martinez N, Neumann K, Benedict RC, et al. Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium. Lancet Reg Health Am. 2023;100553. doi:https://doi.org/10.1016/j.lana.2023.100553