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Living kidney donation in individuals with hepatitis C and HIV infection: rationale and emerging evidence

Luckmini Liyanage1, Abimereki D Muzaale2, Macey L Henderson2

  • 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Current Transplantation Reports
|August 29, 2020
PubMed

Insights

Living donor kidney transplants for individuals with HIV or HCV may increase access for vulnerable end-stage renal disease patients. Careful donor and recipient evaluation is essential to manage risks associated with HIV and HCV living donation.

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Infectious Diseases

Background:

  • Individuals with HIV (HIV+) and hepatitis C virus (HCV+) and end-stage renal disease (ESRD) face limited kidney transplant access.
  • The HIV Organ Policy Equity (HOPE) Act and direct-acting antivirals (DAAs) for HCV present new possibilities for transplantation.
  • Exploring living donor kidney transplantation from HIV+ or HCV+ donors is crucial for improving outcomes.

Purpose of the Study:

  • To evaluate the risks and benefits of living donor kidney transplantation from HIV+ or HCV+ donors.
  • To assess donor health and recipient outcomes in the context of HIV and HCV positive living donation.
  • To determine the potential of these transplants to improve access for vulnerable ESRD populations.

Main Methods:

  • Review of existing clinical experience and empirical evidence regarding organ donation from HIV+ and HCV+ individuals.
  • Analysis of the implications of the HOPE Act for HIV+ living donation.
  • Assessment of outcomes data for HCV seropositive and viremic deceased donor kidney transplants.

Main Results:

  • The HOPE Act allows organ donation from HIV+ individuals, but clinical experience is limited to deceased donors.
  • HIV+ living donors without comorbidities and with controlled infection have a low, acceptable risk of ESRD.
  • Evidence supports good outcomes with HCV+ deceased donors, suggesting potential for HCV+ living donors.

Conclusions:

  • Living donor kidney transplantation involving HIV+ or HCV+ donors can enhance transplant access for ESRD patients.
  • Thorough evaluation and vigilant monitoring are necessary to minimize risks for both donors and recipients.
  • Careful consideration of donor health and recipient outcomes is paramount for successful HIV+ and HCV+ living donor kidney transplantation.
Abstract

Keywords:
HIVHIV Organ Policy Equity Actdirect-acting antiviralshepatitis Cliving donorliving donor transplantation

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