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HIV+ to HIV+ Organ Transplantation Safe, Feasible, Says Malinis

August 08, 2019
by Julie Parry

The August 8, 2019 Department of Internal Medicine’s Medical Grand Rounds, “No HIV Organ Left Behind: Overcoming the Barriers of Organ Transplantation in HIV+ Individuals,” was presented by Maricar Malinis, MD, associate professor of medicine and surgery (transplant) and medical director, Transplant Infectious Diseases Program.

Due to effective antiretroviral therapy (ART), deaths in the HIV+ population has declined. More patients are living with HIV longer, and are also burdened by other chronic diseases, including kidney disease. But, unlike their HIV- counterparts, HIV+ individuals progress to end stage renal disease (ESRD) is more rapid. It is estimated at over 10,000 HIV+ patients will have ESRD. ESRD is the fourth most common cause of non-AIDS related death.

“What can we do to solve this problem?” asked Malinis. “We offer these patients kidney transplantation.”

Malinis cited the study, “Outcomes of Kidney Transplantation in HIV-Infected Recipients,” led by Peter Stock, MD, PhD, that looked at 150 HIV-infected kidney transplant recipients and followed them for three years, looking at patient and graft survival. This early trial showed the feasibility of this transplantation.

Due to the shortages of organs and long wait times for kidney donation in any patient population, Malinis also suggests using HIV+ deceased donor pool. Historically, HIV+ patients were banned from organ donation, but on November 21, 2013, President Barack Obama signed the “HIV Organ Policy Equity Act” or HOPE Act. This new act allowed for organ transplantation between HIV+ individuals under a clinical trial setting.

In March 2016, Johns Hopkins Medical Center performed that first HIV+ to HIV+ organ transplantation. Malinis was instrumental in informing the Johns Hopkins Team and the New England Donor Services of the willingness of the family to donate. The transplant team at Yale New Haven Hospital (YNHH) procured the organ for the procedure at Johns Hopkins as part of the HOPE Trial.

There are currently 31 transplant centers across the U.S. in the trial. YNHH was the sixth one to join.

Kidney transplantation is now the standard of care for HIV+ individuals with ESRD.

To learn more about Malinis’s work and watch Medical Grand Rounds, Yale faculty can review the Grand Rounds video or review her bio.

Submitted by Julie Parry on August 08, 2019