TY - JOUR
T1 - Living kidney donors with HIV
T2 - experience and outcomes from a case series by the HOPE in Action Consortium
AU - HOPE in Action Investigators
AU - Durand, Christine M.
AU - Martinez, Nina
AU - Neumann, Karl
AU - Benedict, Reed C.
AU - Baker, Arthur W.
AU - Wolfe, Cameron R.
AU - Stosor, Valentina
AU - Shetty, Aneesha
AU - Dietch, Zachary C.
AU - Goudy, Leah
AU - Callegari, Michelle A.
AU - Massie, Allan B.
AU - Brown, Diane
AU - Cochran, Willa
AU - Muzaale, Abimereki
AU - Fine, Derek
AU - Tobian, Aaron A.R.
AU - Winkler, Cheryl A.
AU - Al Ammary, Fawaz
AU - Segev, Dorry L.
AU - Agrawal, Neerja
AU - Pereira, Marcus
AU - Ranganna, Karthik
AU - Wolfe, Cameron
AU - Friedman-Moraco, Rachel
AU - Kitchens, William
AU - Adebiyi, Oluwafisayo
AU - Kubal, Chandrashekhar
AU - Cameron, Andrew
AU - Desai, Niraj
AU - Durand, Christine
AU - Ottmann, Shane
AU - Elias, Nahel
AU - Gilbert, Alexander
AU - Smith, Coleman
AU - Castillo-Lugo, Jose A.
AU - Florman, Sander
AU - Massie, Allan
AU - Mehta, Sapna
AU - Hand, Jonathan
AU - Blumberg, Emily
AU - Santos, Carlos A.Q.
AU - Goldberg, Ryan
AU - Mehta, Shikha
AU - Cannon, Robert
AU - Giorgakis, Emmanouil
AU - Schaenman, Joanna
AU - Aslam, Saima
AU - Stock, Peter
AU - Price, Jennifer
AU - Apewokin, Senu
AU - Benamu, Esther
AU - Spaggiari, Mario
AU - Baddley, John
AU - Morris, Michele I.
AU - Simkins, Jacques
AU - Pruett, Timothy
AU - Haidar, Ghady
AU - Wojciechowski, David
AU - Agarwal, Avinash
AU - Balaraman, Vasanthi
AU - Gupta, Gaurav
AU - Chapman, Will
AU - Muthukumar, Thangamani
AU - Small, Catherine B.
AU - Malinis, Maricar
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2023/8
Y1 - 2023/8
N2 - Background: Living kidney donation is possible for people living with HIV (PLWH) in the United States within research studies under the HIV Organ Policy Equity (HOPE) Act. There are concerns that donor nephrectomy may have an increased risk of end-stage renal disease (ESRD) in PLWH due to HIV-associated kidney disease and antiretroviral therapy (ART) nephrotoxicity. Here we report the first 3 cases of living kidney donors with HIV under the HOPE Act in the United States. Methods: Within the HOPE in Action Multicenter Consortium, we conducted a prospective study of living kidney donors with HIV. Pre-donation, we estimated the 9-year cumulative incidence of ESRD, performed genetic testing of apolipoprotein L1 (APOL1), excluding individuals with high-risk variants, and performed pre-donation kidney biopsies (HOPE Act requirement). The primary endpoint was ≥grade 3 nephrectomy-related adverse events (AEs) in year one. Post-donation, we monitored glomerular filtration rate (measured by iohexol/Tc-99m DTPA [mGFR] or estimated with serum creatinine [eGFR]), HIV RNA, CD4 count, and ART. Findings: There were three donors with two-four years of follow-up: a 35 year-old female, a 52 year-old male, and a 47 year-old male. Pre-donation 9-year estimated cumulative incidence of ESRD was 3.01, 8.01, and 7.76 per 10,000 persons, respectively. In two donors with APOL1 testing, no high-risk variants were detected. Biopsies from all three donors showed no kidney disease. Post-donation, two donors developed nephrectomy-related ≥grade 3 AEs: a medically-managed ileus and a laparoscopically-repaired incisional hernia. GFR declined from 103 to 84 mL/min/1.73 m2 at four years (mGFR) in donor 1, from 77 to 52 mL/min/1.73 m2 at three years (eGFR) in donor 2, and from 65 to 39 mL/min/1.73 m2 at two years (eGFR) in donor 3. HIV RNA remained <20 copies/mL and CD4 count remained stable in all donors. Interpretation: The first three living kidney donors with HIV under the HOPE Act in the United States have had promising outcomes at two-four years, providing proof-of-concept to support living donation from PLWH to recipients with HIV. Funding: National Institute of Allergy and Infectious Diseases, National Institutes of Health.
AB - Background: Living kidney donation is possible for people living with HIV (PLWH) in the United States within research studies under the HIV Organ Policy Equity (HOPE) Act. There are concerns that donor nephrectomy may have an increased risk of end-stage renal disease (ESRD) in PLWH due to HIV-associated kidney disease and antiretroviral therapy (ART) nephrotoxicity. Here we report the first 3 cases of living kidney donors with HIV under the HOPE Act in the United States. Methods: Within the HOPE in Action Multicenter Consortium, we conducted a prospective study of living kidney donors with HIV. Pre-donation, we estimated the 9-year cumulative incidence of ESRD, performed genetic testing of apolipoprotein L1 (APOL1), excluding individuals with high-risk variants, and performed pre-donation kidney biopsies (HOPE Act requirement). The primary endpoint was ≥grade 3 nephrectomy-related adverse events (AEs) in year one. Post-donation, we monitored glomerular filtration rate (measured by iohexol/Tc-99m DTPA [mGFR] or estimated with serum creatinine [eGFR]), HIV RNA, CD4 count, and ART. Findings: There were three donors with two-four years of follow-up: a 35 year-old female, a 52 year-old male, and a 47 year-old male. Pre-donation 9-year estimated cumulative incidence of ESRD was 3.01, 8.01, and 7.76 per 10,000 persons, respectively. In two donors with APOL1 testing, no high-risk variants were detected. Biopsies from all three donors showed no kidney disease. Post-donation, two donors developed nephrectomy-related ≥grade 3 AEs: a medically-managed ileus and a laparoscopically-repaired incisional hernia. GFR declined from 103 to 84 mL/min/1.73 m2 at four years (mGFR) in donor 1, from 77 to 52 mL/min/1.73 m2 at three years (eGFR) in donor 2, and from 65 to 39 mL/min/1.73 m2 at two years (eGFR) in donor 3. HIV RNA remained <20 copies/mL and CD4 count remained stable in all donors. Interpretation: The first three living kidney donors with HIV under the HOPE Act in the United States have had promising outcomes at two-four years, providing proof-of-concept to support living donation from PLWH to recipients with HIV. Funding: National Institute of Allergy and Infectious Diseases, National Institutes of Health.
KW - HIV Organ Policy Equity Act
KW - HIV donation
KW - HIV to HIV transplantation
KW - HOPE Act
KW - Living kidney donation
KW - Transplantation from donors with HIV to recipients with HIV
UR - http://www.scopus.com/inward/record.url?scp=85166985014&partnerID=8YFLogxK
U2 - 10.1016/j.lana.2023.100553
DO - 10.1016/j.lana.2023.100553
M3 - Article
C2 - 37600163
AN - SCOPUS:85166985014
SN - 2667-193X
VL - 24
JO - The Lancet Regional Health - Americas
JF - The Lancet Regional Health - Americas
M1 - 100553
ER -