Transplantation of kidneys from HIV-positive donors is “an additional treatment option” for HIV-positive patients who require renal replacement therapy, suggest Elmi Muller and colleagues. In their new paper, these researchers report the medium-term outcomes of HIV-positive-to-HIV-positive kidney transplantation in Groote Schuur Hospital, South Africa.

Credit: NPG

“In 2008, when the HIV-positive-to-HIV-positive program started, patients with end-stage renal disease and HIV infection in South Africa would be turned down for dialysis—and doomed to die—because they were seen as unfit to undergo kidney transplantation in the long-term,” explains Muller. “It made sense to try and marry HIV-positive deceased donors with HIV-positive patients who did not have any other treatment options.”

Among 27 HIV-positive recipients of kidneys from HIV-positive donors, cumulative patient survival was 84% at 1 year and at 3 years, decreasing to 74% at 5 years; graft survival was 93% at 1 year and 84% at 3 years and at 5 years. Rates of graft rejection were 8% at 1 year and 22% at 3 years. Importantly, plasma HIV load did not increase after transplantation.

The researchers conclude that the outcomes of kidney transplantation between HIV-positive donors and “carefully selected” HIV-positive recipients are likely to be similar to outcomes in other high-risk recipients. “Use of HIV-positive donors might resolve some of the problems we face in obtaining transplants for HIV-positive patients,” says Muller.