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

Christine M Durand; Nina Martinez; Karl Neumann; Reed C Benedict; Arthur W Baker; Cameron R Wolfe; Valentina Stosor; Aneesha Shetty; Zachary C Dietch; Leah Goudy; Michelle A Callegari; Allan B Massie; Diane Brown; Willa Cochran; Abimereki Muzaale; Derek Fine; Aaron A R Tobian; Cheryl A Winkler; Fawaz Al Ammary; Dorry L Segev; HOPE in Action Investigators

doi:10.1016/j.lana.2023.100553

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

Lancet Reg Health Am. 2023 Jul 24:24:100553. doi: 10.1016/j.lana.2023.100553. eCollection 2023 Aug.

Authors

Christine M Durand¹, Nina Martinez², Karl Neumann³, Reed C Benedict⁴, Arthur W Baker⁵, Cameron R Wolfe⁵, Valentina Stosor⁶, Aneesha Shetty⁶, Zachary C Dietch⁶, Leah Goudy⁶, Michelle A Callegari⁶, Allan B Massie⁷, Diane Brown¹, Willa Cochran¹, Abimereki Muzaale⁸, Derek Fine¹, Aaron A R Tobian⁹, Cheryl A Winkler¹⁰, Fawaz Al Ammary¹, Dorry L Segev⁷; HOPE in Action Investigators

Collaborators

HOPE in Action Investigators:
Neerja Agrawal, Marcus Pereira, Karthik Ranganna, Cameron Wolfe, Rachel Friedman-Moraco, William Kitchens, Oluwafisayo Adebiyi, Chandrashekhar Kubal, Andrew Cameron, Niraj Desai, Christine Durand, Shane Ottmann, Nahel Elias, Alexander Gilbert, Coleman Smith, Jose A Castillo-Lugo, Sander Florman, Dorry L Segev, Allan Massie, Sapna Mehta, Valentina Stosor, Jonathan Hand, Emily Blumberg, Carlos Aq Santos, Ryan Goldberg, Shikha Mehta, Robert Cannon, Emmanouil Giorgakis, Joanna Schaenman, Saima Aslam, Peter Stock, Jennifer Price, Senu Apewokin, Esther Benamu, Mario Spaggiari, John Baddley, Michele I Morris, Jacques Simkins, Timothy Pruett, Ghady Haidar, David Wojciechowski, Avinash Agarwal, Vasanthi Balaraman, Gaurav Gupta, Will Chapman, Thangamani Muthukumar, Catherine B Small, Maricar Malinis

Affiliations

¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Donor 1, GA, USA. ORCiD ID: 0000-0003-4686-0674.
³ Donor 2, VA, USA.
⁴ Donor 3, IL, USA.
⁵ Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
⁶ Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁷ Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.
⁸ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁹ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁰ Cancer Innovation Laboratory, Center for Cancer Research, NCI and Basic Research Program, Frederick National Laboratories for Cancer Research, Frederick, MD, USA.

Abstract

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.

Keywords: HIV Organ Policy Equity Act; HIV donation; HIV to HIV transplantation; HOPE Act; Living kidney donation; Transplantation from donors with HIV to recipients with HIV.

Abstract

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