VCU news

By Alex Nowak

Thousands of patients across the nation need lifesaving kidney transplants. In 2014 alone, 4,270 patients in the U.S. died waiting for a transplant. Researchers continuously search for ways to expand the donor pool and create opportunities to save more lives.

VCU Medical Center is participating in a clinical research trial to explore one such opportunity: kidney transplants from HIV-positive donors to HIV-positive patients. This effort will allow the transplant of approximately 500 more kidneys per year.

Many patients living with HIV require kidney transplants due to the long-term effects of their treatment. In the late 1980s, a class of medications called highly active anti-retroviral therapy was developed. The therapy offers HIV patients a chance to live with a chronic illness, rather than a fatal disease.

However, while these medications improve quality of life for HIV patients, they can lead to a syndrome called HIV nephropathy. Kidney transplantation is widely accepted as the treatment of choice for HIV patients with kidney failure, HIV nephropathy, and other end-stage renal diseases.

For many years, only HIV-negative individuals could donate organs to HIV-positive patients. In 2013, the federal HIV Organ Policy Equity (HOPE) Act was signed into law, allowing for research into transplanting organs from HIV-positive donors into HIV-positive recipients.

There have been many successful organ transplants between donors and patients with Hepatitis C, demonstrating the potential for HIV-positive donors and patients. The U.S. Department of Health and Human Services has determined that it is safe to use HIV-positive organs in transplants for HIV-positive patients taking highly active anti-retroviral therapy.

“Utilization of HIV-positive donor kidney transplants for HIV-positive patients can significantly increase the organ pool for HIV-positive patients,” said Gaurav Gupta, M.D., associate professor and program director of the transplant nephrology fellowship at VCU Health. “This can reduce the wait time for these patients and thus reduce the significant risk of death they face while on dialysis.”

VCU Health was approved to participate in research under the HOPE Act in September 2016. Today, the Hume-Lee Transplant Center is at the forefront of new treatment as one of 25 transplant centers in the U.S. participating in a clinical research study for HIV-positive patients with end-stage renal disease. The study seeks to learn whether kidney transplants from deceased HIV-positive donors are as safe and effective in HIV-positive recipients as transplants from deceased HIV-negative donors. To date, more than 80 HIV-positive patients nationwide have received kidney transplants, including VCU Health’s first transplant in June 2018.

“Our first patient has excellent kidney function and echoes experiences reported by the other few centers across the country who are doing these transplants,” Gupta said. “Our early experience, if proven safe, can also be applied to other organ transplants — liver, heart, pancreas and lungs.”

VCU Health has offered services for HIV patients for many years, providing high-quality treatment and support, Gupta said. The ability to perform this new type of transplant gives patients more options and an expanded donor pool. Patients also benefit from the shorter transplant wait times at the Hume-Lee Transplant Center, where the average wait time is nearly half that of nearby health systems, Gupta said.