Kidney transplantation from deceased donors who had the human immunodeficiency virus (HIV) to people living with HIV and end-stage kidney disease is safe and consistently yields positive outcomes, according to researchers at Johns Hopkins Medicine and 13 other medical institutions. They say their finding could pave the way for more HIV-positive organs of all types — not just kidneys — being available for lifesaving transplants for people with HIV who need them.

The study was posted online on July 23, 2020, by the American Journal of Transplantation. It was performed under the authority of the HIV Organ Policy Equity (HOPE) Act, passed by Congress and signed into law in 2013. The act allows organ transplants from donors with HIV to recipients with HIV in approved U.S. research studies.

“This is an exciting culmination of 10 years of work: estimating the national impact of HIV-to-HIV transplants in 2011, helping write the HOPE Act in 2013, performing the first HIV-to-HIV transplants in the United States in 2016, and now collaborating across the country to demonstrate the safety of this procedure,” says Dorry Segev, M.D. Ph.D., professor of surgery and epidemiology at the Johns Hopkins University School of Medicine and co-leader of the HOPE in Action study team. “Fully successful implementation of the HOPE Act could mean hundreds of additional transplants and hundreds of additional lives saved each year.”

Between March 2016 and July 2019, the HOPE in Action team enrolled 75 adults with end-stage kidney disease and HIV whose virus was suppressed by anti-HIV therapy. Of the participants, 25 received kidneys from deceased donors with HIV and 50 received kidneys from deceased donors without HIV.

All participants survived transplantation, with median follow-up of 1.4 years for recipients of HIV-positive kidneys and 1.8 years for recipients of HIV-negative kidneys. At one year after transplantation, overall graft survival was excellent and comparable between HIV-positive kidneys (91%) and HIV-negative kidneys (92%). Additionally, there were no differences in hospitalizations due to infections, rates of serious adverse events or HIV-related complications, which were rare.

“People living with HIV face a higher risk of kidney failure than those without the virus, but their lack of access to suitable donor organs has previously meant many deaths while waiting for a transplant,” says Christine Durand, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine and co-leader of the HOPE in Action study team. “So it’s a major step forward for our study to show that transplant outcomes using HIV-positive organs are comparable to HIV-negative ones.”

In a 2011 study, also published in the American Journal of Transplantation, a team led by Brian Boyarsky, M.D., a surgical research fellow and assistant resident at the Johns Hopkins University School of Medicine, estimated that 300 to 500 people with HIV could become deceased organ donors every year, potentially providing as many as 1,000 transplants annually for recipients living with the virus.

The new study provides solid evidence that the increase to the organ donor pool predicted nearly a decade ago is possible.

The work was primarily funded by the National Institute of Allergy and Infectious Diseases with additional support from the National Cancer Institute.