Promising Outcomes Seen for Living Kidney Donors With HIV

MONDAY, July 31, 2023 (HealthDay News) — Outcomes are encouraging for the first three living kidney donors with HIV, according to research published online July 24 in The Lancet Regional Health: Americas.

In a prospective study, Christine M. Durand, M.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues reported on the first three cases of living kidney donors with HIV. The nine-year cumulative incidence of end-stage renal disease (ESRD) was estimated predonation and genetic testing of apolipoprotein L1 (APOL1) was performed, excluding individuals with high-risk variants. Grade 3 or greater nephrectomy-related adverse events (AEs) in year 1 were assessed as the primary end point.

The researchers found that three donors had two to four years of follow-up: a 35-year-old woman, a 52-year-old man, and a 47-year-old man. The nine-year estimated cumulative incidence of ESRD was 3.01, 8.01, and 7.76 per 10,000 persons, respectively, predonation. No high-risk variants were detected in two donors with APOL1 testing. Two donors developed nephrectomy-related grade 3 or greater AEs postdonation, a medically managed ileus and a laparoscopically repaired incisional hernia. Glomerular filtration rates decreased from 103 to 84 mL/min/1.73 m² at four years in donor 1 (measured by iohexol/Tc-99m DTPA) and from 77 to 52 mL/min/1.73² and 65 to 39 mL/min/1.73 m² (estimated with serum creatinine) at three and two years in donors 2 and 3, respectively. In all donors, HIV RNA remained <20 copies/mL and CD4 count remained stable.

“The approach to evaluation and follow-up provides additional transplantation options to benefit both potential donors and recipients with HIV,” the authors write.

Several authors disclosed ties to the pharmaceutical industry.