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For the first time, a person living with HIV donated a kidney to a transplant recipient also living with HIV. A multidisciplinary team from Johns Hopkins Medicine completed the HIV-HIV living donor kidney transplant on March 25th. The doctors say that the donor and the recipient are doing well.
"This is the first time in the world that a person living with HIV is allowed to donate kidney. It's huge, "said Dorry Segev, MD, Ph.D., professor of surgery at the Johns Hopkins University School of Medicine. "An illness that was a death sentence in the 1980s has become such a well-controlled disease that people living with HIV can now save lives by donating kidney – that's amazing."
People living with HIV have not yet been able to donate their kidneys because there is concern that HIV is a high risk factor for kidney failure in the donor. However, recent research by Segev and colleagues on more than 40,000 people living with HIV has shown that new antiretroviral drugs are safe for the kidneys, and that those with well-controlled HIV are basically at the same risk as those with HIV. who are not and who are in good health. donate kidneys.
"What is significant for the first living kidney donor – who also lives with HIV – is that it advances medicine while fighting stigma, it challenges providers and the public to see HIV differently," he says. says Christine Durand, badociate professor of medicine and oncology and a member of the Kimmel Johns Hopkins Comprehensive Cancer Center. "While patients waiting for a transplant find that we are working with as many donors as possible to save as many lives as possible, we are giving them hope." Any successful transplant shortens the list waiting for all patients, regardless of their HIV status. "
Durand and Segev lead HOPE in Action, an initiative that brings together numerous national studies exploring the feasibility, safety and effectiveness of HIV transplants. This innovation was made possible by Segev's design and advocacy for the 2013 Federal Law on Equity in HIV-related Organs (HOPE Act). In addition to leading the team that performed the first-ever donor transplant HOPE in the US in 2016, she is leading two NIH-funded trials on HIV-to-HIV kidney and liver transplantation. This first live kidney donor transplant is the next important step in HOPE.
"Do not call me a hero, call me first, I want to see who comes next."
Nina Martinez, the 35-year-old kidney donor living with HIV, learned of the existence of the HOPE law at the time of its adoption in 2013. Yet, until she sees a Scenario on the medical drama Gray's Anatomy a few months later, she did not realize where her own life would intersect with a kidney donation. The editors of Gray's Anatomy have created a scenario about the first live kidney donor living with HIV, and Martinez has seen what his future might be.
"One of my friends and neighbors, who herself became a living kidney donor, also inspired me," Martinez said. "Participating in clinical research is, for me, extremely important, I testified that my friend had performed a life-saving transplant and I was watching her, so I knew that if I could help somebody Another, I had to do it, so under a research protocol was very comfortable for me. "
Martinez lives in Atlanta and is a public health consultant, clinical research volunteer, and policy advocate dedicated to eliminating the stigma that still surrounds HIV.
"Some people think that people living with HIV are" sick "or look uncomfortable," Martinez said. "For me, I knew I was in good health. HIV was no longer a legal impediment to organ donation and I have never considered HIV as a medical barrier. As a policy advocate, I want people to change what they think they know. about HIV. I do not want to be the hero of anyone. I want to be the example of someone, the reason why someone might consider donating. "
In July 2018, Martinez read on Facebook that a friend who also had HIV needed a kidney transplant. Martinez felt compelled to look for a way to bring HOPE to her friend. Familiar with the medical research process and public health policy, she contacted Johns Hopkins.
After having corresponded with Segev about the possibility of donating, Martinez went to Baltimore in October 2018 to undergo an badessment of his potential in donating kidneys to the Johns Hopkins Hospital. The tests required several trips to be badyzed in order to ensure that she was healthy enough to donate, which is the norm in the evaluation of potential kidney donors.
But before she was released, her friend died. She attended the funeral and considered her options. Martinez, while her friend was distressed, decided that she was always willing to donate, now to a person she would not know – an anonymous recipient.
"Despite the loss of my friend because of kidney disease, I wanted to go ahead with a donation to honor them," Martinez said. "I could do it for someone else, not because I am special, but because I am strong." Other people living with HIV before me participated in clinical research so that I can not just survive but thrive – it's my turn to do it, both for my friend who was close to my heart and for all the people waiting for a transplant. "
During their badessment, the surgical team confirmed that Martinez had healthy kidneys and a low viral load, which met the criteria required by the federal HOPE warranties. Once she was cleared, she gave a kidney to a recipient who wishes to remain anonymous.
In an article published in 2018 by the American Journal of Transplant, surgeons investigated the factors allowing to identify candidates healthy enough to donate a kidney. People whose HIV is well controlled, with no history of diabetes, uncontrolled high blood pressure or protein in the urine could be healthy enough to donate.
Physicians will continue to closely monitor the recipient and the donor. In light of the new predictors and highly effective antiretroviral treatment options available, the team is optimistic about the long-term effectiveness of HIV control and kidney function.
According to the United Network for Organ Sharing, about 113,000 people were on the waiting list of transplants in the United States in March 2019. About 20 Americans die every day waiting for transplants; the longest waiting list for a transplant involves a kidney. People living with HIV who volunteer as living donors could potentially save the lives of thousands of people living with HIV who need a transplant each year.
Since the decisive transplant of Johns Hopkins in 2016, there have been more than 50 deceased donors under the HOPE law and more than 100 transplant recipients under a HOPE protocol in the United States.
Source: Johns Hopkins Medicine
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