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One Historic HIV Organ Transplant, Numerous Team Members

02/21/2017
Published in Surgery - Spring 2017
In March 2016, Johns Hopkins surgeons performed the first organ transplants in the U.S. from a deceased donor with HIV to patients with HIV. Liver transplant surgeon Andrew Cameron and kidney transplant surgeon Niraj Desai say the surgeries are nearly the same as for any other transplants. The difference is at the microscopic level—particularly in ensuring that a more virulent strain of HIV is not introduced to recipients.

Infectious disease physicians play a significant preoperative role in vetting the donor organ for level of disease. Postoperatively, pharmacists aim to avoid known medication interactions. Because HIV medicines can interfere with the immunosuppressants required after an organ transplant, patients’ drug levels are monitored closely.

Specialists from many disciplines played a role in the transplants from a deceased donor with HIV to a patient with HIV (see sidebar). They also take part in every transplant at the Johns Hopkins Comprehensive Transplant Center. All transplants are multidisciplinary endeavors, involving more than a dozen specialized team members.

Thanks to the complex nature of care, Cameron says the first-in-the-U.S. operations have been a great success, as have been the several HIV transplants that have taken place since.

The Research Road to Transplant

The HIV transplant would not have been possible without decades of dedication from Johns Hopkins clinician-researchers. Over the last 10 years, they have conducted national studies evaluating patients with HIV who had organ transplants. “The patients did very well,” says Cameron, “and the outcomes were indistinguishable from patients without the disease.”

In 2013, transplant surgeon Dorry Segev championed the passage of the HIV Organ Policy Equity Act, which permits people with HIV to donate organs. Soon after, Johns Hopkins gained approval from the United Network for Organ Sharing to perform HIV-positive to HIV-positive organ transplants.

“We are looking at the long-term outcomes and if they are positive, eventually we hope to do a lot of transplants for the HIV-positive population,” says Cameron. “And because we have access to a pool of organs we previously didn’t use, the wait time for these organs went from years to weeks.” A study published in the American Journal of Transplantation in March 2011 showed that the pool of potential organ donors for HIV patients increased to as many as 600 per year conservatively.

The center is currently taking referrals for patients with HIV who need an organ transplant. With clinics available in the Greater Maryland and Washington, D.C., area, it is easier than ever to access Johns Hopkins care for organ transplantation.