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Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium.

Publication ,  Journal Article
Durand, CM; Martinez, N; Neumann, K; Benedict, RC; Baker, AW; Wolfe, CR; Stosor, V; Shetty, A; Dietch, ZC; Goudy, L; Callegari, MA; Massie, AB ...
Published in: Lancet Reg Health Am
August 2023

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.

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Published In

Lancet Reg Health Am

DOI

EISSN

2667-193X

Publication Date

August 2023

Volume

24

Start / End Page

100553

Location

England
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Durand, C. M., Martinez, N., Neumann, K., Benedict, R. C., Baker, A. W., Wolfe, C. R., … HOPE in Action Investigators, . (2023). Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium. Lancet Reg Health Am, 24, 100553. https://doi.org/10.1016/j.lana.2023.100553
Durand, Christine M., Nina Martinez, Karl Neumann, Reed C. Benedict, Arthur W. Baker, Cameron R. Wolfe, Valentina Stosor, et al. “Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium.Lancet Reg Health Am 24 (August 2023): 100553. https://doi.org/10.1016/j.lana.2023.100553.
Durand CM, Martinez N, Neumann K, Benedict RC, Baker AW, Wolfe CR, et al. Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium. Lancet Reg Health Am. 2023 Aug;24:100553.
Durand, Christine M., et al. “Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium.Lancet Reg Health Am, vol. 24, Aug. 2023, p. 100553. Pubmed, doi:10.1016/j.lana.2023.100553.
Durand CM, Martinez N, Neumann K, Benedict RC, Baker AW, Wolfe CR, Stosor V, Shetty A, Dietch ZC, Goudy L, Callegari MA, Massie AB, Brown D, Cochran W, Muzaale A, Fine D, Tobian AAR, Winkler CA, Al Ammary F, Segev DL, HOPE in Action Investigators. Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium. Lancet Reg Health Am. 2023 Aug;24:100553.

Published In

Lancet Reg Health Am

DOI

EISSN

2667-193X

Publication Date

August 2023

Volume

24

Start / End Page

100553

Location

England