Washington: Surgeons at the Johns Hopkins Hospital have transplanted a kidney from a living HIV-positive donor to an HIV-positive recipient, a medical breakthrough they hope will expand the pool of available organs and help change perceptions of HIV.
The donor, 35-year-old Nina Martinez, and the recipient, who chose to remain anonymous, are recovering in the hospital after Monday’s surgery, doctors said. The recipient no longer needs kidney dialysis for the first time in a year.
The procedure is another step in the evolution of HIV — considered to mean certain death when the AIDS epidemic began in 1981 — and an advance for the 1.1 million people who carry the virus. Medication now can suppress the infection to undetectable levels in many people, and President Donald Trump recently vowed to end transmission of it in the United States by 2030. But stigma still remains.
“Society perceives me and people like me as people who bring death,” Martinez said in an interview Saturday before the operation. “And I can’t figure out any better way to show that people like me can bring life.”
Martinez, who acquired HIV from a blood transfusion as an infant, is expected to speak when Hopkins holds a news conference at 1pm. Thursday to announce the surgery, the first of its kind anywhere.
Surgeons have transplanted 116 organs from deceased HIV-positive donors to recipients with HIV since 2016, when a new law allowing that surgery took effect. Among people without HIV, more than 152,000 kidneys from living donors have been transplanted over the past 30 years, and a few hundred livers from live donors are implanted each year.
More than 113,000 people are on the US waiting list for organ transplants, most of them seeking kidneys. Others are too sick to be listed or are taken off the list when their disease progresses too far.
Until now, leaving an HIV-positive person with just one kidney was considered too dangerous because the infection and the medications that control it increase the chances of kidney disease.
But a 2017 study of 42,000 people led by Hopkins researchers showed that for some healthy HIV-positive donors, the risk of developing serious kidney disease is not much greater than it is for many HIV-negative people, especially those who engage in behaviours such as smoking.
“People with HIV today can’t donate blood. But now they’re able to donate a kidney,” said Dorry Segev, a professor of surgery at the Johns Hopkins University School of Medicine, who led the research team and removed Martinez’s left kidney. “They have a disease that 30 years ago was a death sentence. Today they’re so healthy they can give someone else life.”
The organ was implanted in the recipient by a separate team of surgeons, the normal procedure in transplantation. The operation was performed by Niraj Desai, an assistant professor of surgery at Hopkins.
The kidney was implanted near the recipient’s pelvis through a six-to-eight inch incision in the abdomen, and the recipient’s kidneys were not removed, as is common practice, Desai said. On average, kidney recipients can expect 10 to 15 years out of a transplanted kidney, Desai said, though recipients of live kidney donation tend to do a little better than those who receive organs from deceased donors. After that period, the current recipient would require another transplant or go back on dialysis, he said.
Martinez and the recipient will remain on antiretroviral medication indefinitely to control their HIV. Resistance to HIV medication can vary from person to person, so doctors must monitor the recipient closely in the months after the donor organ is introduced. The recipient will also take drugs to prevent organ rejection, and those are not expected to significantly interfere with the HIV-suppressing medications.
Martinez is in near-normal physical health. Her viral load is undetectable. “Her health is excellent. Her HIV is well controlled. Her immune system is essentially normal,” said Christine Durand, an associate professor of medicine at Hopkins and a member of the team that evaluated Martinez.
In 1983, Martinez and her twin sister were born 12 weeks prematurely in San Jose and soon developed anaemia. The daughter of a naval officer, Martinez was taken to a military hospital in San Francisco for a blood transfusion in the days before the supply was tested for HIV, and she acquired the infection. She and her family were not aware of the infection until she was checked before eye surgery at the age of 8.
She was watched in school to ensure that she wasn’t a health hazard to other children, she said. She later learnt that one principal asked: “Why are we educating her with public dollars if she’s going to die?” When a housemate found out she had HIV, he moved out, leaving his belongings behind.
“It gives me great joy to know that I’m putting a story like this out there,” she said. “Because those people need a mental reboot.”
A public health consultant who lives in Atlanta, Martinez was aware of the HIV Organ Policy Equity Act when it was enacted in 2013. The next year, she saw an episode of the television show “Grey’s Anatomy” in which the writers invented a story about a transplant from a live HIV-positive donor. She eventually contacted Segev and volunteered for the gruelling regimen of tests that led her to become the first person in the Hopkins clinical trial.
She believes her choice will ripple down the transplant waiting list.
“When I take this recipient off the list, everyone moves up,” she said, “whether they have HIV or not.”