Johns Hopkins performs first HIV+ liver transplant

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Legal victory

But the victory lies in legal battle won, rather than the breakthrough surgery.

When the National Organ Transplant Act was passed in the US in 1984, the HIV/Aids pandemic was at its peak, with a certain death sentence hanging over it. Today, with advances in medical science, HIV is seen as nothing more than manageable chronic condition.

However, according to the Baltimore Sun, HIV patients were on transplant for an average of six years, which was unacceptable to Dr Dorry Segev, as he watched in frustration as patients dies and HIV-positive organs discarded because HIV-to-HIV transplants were prohibited.

"It wasn't a medical issue," Segev, an associate professor of surgery and epidemiology at Hopkins School of Medicine, says. "It was entirely legal."

Championing the cause

“But times and medicine changed, giving Segev the opening to champion an effort to overturn the ban. He and his colleagues made repeated trips to Capitol Hill to meet with any legislative assistant who would give them time and help them navigate the bureaucracy of Congress to persuade lawmakers that a change in policy was warranted,” the report says.

He conducted research, published in the American Journal of Transplantation in 2011, that 500 to 600 HIV-infected donors annually would be eligible to donate kidneys, livers and other organs if the prohibition were lifted, saving about 1,000 lives each year.

In 2013, President Barack Obama signed into law the HIV Organ Policy Equity (Hope) Act, legislation that allowed scientists to carry out research into organ donations from one person with HIV to another.

“This could mean a new chance at life,” says Dr Segev.

The kidney recipient is recuperating at home, while the liver recipient is expected to be discharged soon.

The South African connection

The positive-to-positive renal transplant was pioneered in South Africa, and Dr Elmi Muller, head of the Groote Schuur Hospital transplant unit and president of the Southern African Transplantation Society, and her team have being carrying them out since 2008.

The results of the South African research, were published in the New England Journal of Medicine, last year and showed that people with renal failure who get a donated kidney from another person with HIV/Aids fare as well as patients who get one from an uninfected donor.

“The work shows that the procedure is safe and effective up to five years down the line,” says an article published in Business Day.

Good prognosis

Dr Muller and her team tracked the progress of 27 HIV/ Aids patients for three to five years, monitoring them for possible ‘superinfection’ from a second strain of HIV, as well as the effect of the immune system-suppressing drugs — to stop the organ from being rejected — on the progression of their HIV infection.

They found their patients had comparable survival rates to patients who had received kidneys from donors who were HIV-negative. The survival rate among the patients was 84% after one year, 84% after three years, and 74% after five years.

“It was important because it opened up a new pool of desperately needed kidney donors for HIV/Aids patients, who are especially vulnerable to renal failure, Dr Muller says in the report.