A Johns Hopkins study finds that HIV-positive kidney
transplant recipients could have the same one-year survival
rates for themselves and their donor organs as those without
HIV, provided certain risk factors for transplant failure
are recognized and tightly managed.
"Kidney transplantation is a viable and necessary option for
HIV-positive patients with chronic kidney disease,
especially since kidney disease is taking such a large toll
on this group," said Jayme Locke, a resident in the Department of
Surgery at Johns Hopkins University School of Medicine
and lead researcher of the study described in the January
issue of the Archives of Surgery.
Traditionally, HIV patients were not considered transplant
candidates because survival rates after transplantation were
thought to be greatly compromised by the disease, which
cripples the body's immune system. Also, transplant patients
take drugs that suppress their immune systems in order to
prevent organ rejection, a regimen thought to further
threaten HIV patients' already fragile immune systems.
Locke says that the researchers' study results are in part a
reflection of newer antiretroviral therapies that have
reduced HIV death rates by 80 percent. Indeed, people with
HIV now die of chronic diseases, like most other people,
rather than from the opportunistic infections that once took
a grave toll. Kidney disease, for example, accounts for more
than 10 percent of HIV-related deaths.
For the study, Locke and her team looked at the one-year
kidney survival rates and one-year patient survival rates of
36,492 HIV-negative and 100 HIV-positive kidney transplant
recipients listed on the United Organ Sharing Network list
who received transplants between January 2004 and June 2006.
They excluded those under 18 and anyone who had multi-organ
The chances of survival were the same in both groups.
However, kidney survival rates in these two groups showed
that HIV-negative recipients had a 94.6 percent survival
rate, compared to 87.9 percent in people with HIV. (People
can survive on dialysis even if their transplanted kidney
When the investigators broke down the results into subgroups,
however, they learned that some of the kidneys transplanted
into HIV-positive recipients were relatively late getting to
full function. This so-called delayed graft function reduced
kidney survival by 30 percent. When this group was removed
from the rate comparison, HIV-positive and -negative groups
had equal kidney and patient survival rates, Locke said.
According to Locke, this is significant because delayed graft
function can be avoided by controlling certain negative risk
factors such as advanced organ-donor age, deceased-donor
kidneys (vs. live-donor kidneys) and long cold ischemic
times (the time the kidney is without blood flow before
Other researchers from Johns Hopkins who contributed to this
study are Robert Montgomery, Daniel S. Warren, Dorry Segev
and Aruna Subramanian.