Research: HIV No Bar to Organ Transplant Success
Patients with HIV are successfully receiving liver and kidney transplants, researchers reported Thursday, challenging widespread reluctance by transplant centers to give scarce organs to people with the incurable disease.
The research, presented at a transplant conference in Miami, offers the latest medical ripple traced to the powerful drugs that revolutionized AIDS care in the mid-1990s. Because thousands of HIV patients are living longer with the drugs, some develop organ failure for other reasons, making them candidates for transplants.
The competition for organs is fierce. More than 80,000 people are waiting for transplants, and more than 6,000 die each year waiting. While livers and kidneys are typically given to the sickest patients waiting, doctors will not give organs to anyone who is too sick to benefit; in many places, that means anyone who is HIV positive.
Just four or five hospitals offer organs to HIV-positive patients, with most others arguing that limited organs should be saved for patients who do not have another disease complicating their chances for survival. There have also been concerns that drugs that must be taken after transplants may exacerbate patients’ HIV, the virus that causes AIDS.
Still, an editorial last month in the New England Journal of Medicine argued that these patients should be considered eligible for transplants just like other patients who have chronic diseases such as hepatitis C and diabetes, or older patients, all of whom face lower long-term survival chances. HIV, they said, is just another medical factor to consider in the equation.
Others say there isn’t enough data on the long-term survival of patients with HIV to justify taking an organ that would have gone to an otherwise healthy patient.
“It’s true agony for patients on waiting lists, who wonder if they’ll live to get transplanted,” said Dr. Marlon Levy, surgical director for liver and kidney transplantation at Baylor All Saints Medical Center in Fort Worth, one of the nation’s busiest transplant centers. “It just becomes an almost overwhelming burden to consider transplantation for someone who has another illness when there are so many people who don’t have those barriers.”
So far, the transplants in HIV patients have proved successful, according to data presented Thursday at the International Congress of the Transplantation Society, taken from several U.S. centers and one in France that offer kidneys and livers to HIV-positive patients. A year or so after their transplants, these patients are just as likely to survive as other transplant recipients, they said.
