Transplants for HIV Patients Reported Complex But Successful

A small but growing number of patients with HIV are now receiving liver and kidney transplants, and researchers reported at the 19th International Congress of The Transplantation Society that the success rate appears to be very similar to that of transplant patients without the infection.

While patients with HIV until recently were not considered transplant candidates, powerful drugs have turned the HIV infection into a chronic condition much like hepatitis or diabetes, and a handful of major transplant centers are now willing to transplant organs to HIV patients.

However, while the survival rates reported thus far are good, managing the mix of immunosuppressive drugs and anti-retroviral therapies for HIV in a way that doesn't result in a worsening of the HIV infection, the rejection of the transplanted organ, or a toxic drug interaction presents a major challenge, according to the researchers.

For example, Dr. Didier Samuel of Paul Brousse Hospital in Villejuif, France, reported that drug interactions between the immunosuppressive drug Prograf and protease inhibitors caused an acute rejection in one patient and toxic levels of Prograf in another.

And Dr. Peter Stock of the University of California, San Francisco reported that patients on protease inhibitors required only 25 percent of the dose of the immunosuppressive drug cyclosporine compared to patients on non-nucleoside reverse transcriptase inhibitors.

But he said that of the four liver and 10 kidney transplants performed in HIV-positive patients at UCSF, HIV viral loads have remained undetectable in all patients on anti-retroviral therapy, and the only death occurred in a 15-year-old who died as a result of a rapid recurrence of hepatitis C.

At other major centers performing the transplants:

• 17 of 20 HIV-positive kidney recipients transplanted at Hahnemann University Hospital in Philadelphia are alive a year after their transplants. One patient studied lost his graft to vascular rejection because a drug interaction with one of the medications in the highly active anti-retroviral therapy (HAART) made it difficult to achieve therapeutic levels of the anti-rejection drugs.
• All 6 HIV-positive liver recipients transplanted at the University of Miami/Jackson Memorial Hospital are alive up to three years after their transplants.
• All 4 kidney recipients transplanted at the University of Pittsburgh Medical Center, and 5 of the 7 liver recipients, are alive several months to five years after their transplants.

"Many of these patients are young, in their 20s and 30s, and they do not have obvious AIDS diseases. They're simply carriers of the HIV virus," said Dr. Anil Kumar, chief of transplantation at Hahnemann Hospital.

"The results seem to be very satisfactory and comparable to non-HIV patients," said Dr. Andreas Tzakis, director of the liver transplant program at the University of Miami.

"There's no reason to be biased against them," agreed Dr. John Fung, director of the liver transplant program at the University of Pittsburgh.

Other sources: XIX International Congress of The Transplantation Society