THURSDAY, Nov. 18 (HealthDay News) -- A large, new study
provides more evidence that people infected with HIV, the virus
that causes AIDS, do almost as well on the survival front as other
patients when they undergo kidney transplants.
Up until the mid-1990s, physicians tended to avoid giving kidney
transplants to HIV patients because of fear that AIDS would quickly
kill them. Since then, new medications have greatly lengthened life
spans for HIV patients, and surgeons routinely perform kidney
transplants on them in some urban hospitals.
The study authors, led by Dr. Peter G. Stock, a professor of
surgery at the University of California, San Francisco, examined
the medical records of 150 HIV-infected patients who underwent
kidney transplantation between 2003 and 2009. They report their
findings in the Nov. 18 issue of the
New England Journal of Medicine.
The researchers found that about 95 percent of the transplant
patients lived for one year and about 88 percent lived for three
years. Those survival rates fall between those for kidney
transplant patients in general and those who are aged 65 and
"They live just as long as the other patients we consider for transplantation. They're essentially the same as the rest of our patients," said transplant specialist Dr. Silas P. Norman, an assistant professor of internal medicine at the University of Michigan. Norman was not part of the study team.
There was one troubling finding: the bodies of HIV patients were
more likely to reject the kidneys than the bodies of other
transplant patients. It's likely that surgeons will need to better
tailor their procedures to help prevent organ rejection, said
transplant surgeon Dr. Dorry Segev. This should happen as surgeons
gain more experience with transplants in HIV patients, said Segev,
an associate professor of surgery and epidemiology at Johns Hopkins
Medical Institutions, who was familiar with the study findings.
Overall, Segev said, "treatment of HIV-infected patients
undergoing kidney transplantation is clearly not straightforward,
and this study has identified some challenges for the transplant
community to address."
On the bright side, transplant procedures didn't appear to have
much of an impact on the HIV infections in the patients.
In years past, Norman said, transplant surgeons worried about
how the AIDS virus would interact with the medications given to
transplant patients that are designed to dampen the immune system.
The concern was that "these patients are now doing well, and you're
going to give them medicine and undo all their benefits," he
But it turns out that transplantation drugs have the opposite
effect and often suppress the AIDS virus, he said. This is because
HIV revs up the immune system while the drugs turn it down, he
Norman said he expects that the new findings will encourage more
surgeons to perform kidney transplants on HIV patients, who are
frequently surviving long enough to develop diseases that typically
target older people.
"There are still a lot of people in the community, including transplant professionals, nephrologists and infectious disease professionals, who still don't appreciate that many of these patients are good prospects for transplantation," Norman said. "They don't appreciate how many procedures have been done to date, and how we're getting overall very good outcomes."
For more about
kidney transplants, try the U.S. National Library of Medicine.
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