AIDS Patients Do OK with Transplants
October 17, 2001
According to researchers at the World Congress of Nephrology in San Francisco, patients infected with HIV appear to do well following the receipt of donor kidneys and livers. Despite the fact that patients routinely must receive cyclosporine, an immuno-suppressant administered so that organ rejection does not occur, HIV/AIDS patients do gain from the operation. "Frankly, a lot of us thought that giving cyclosporine to these patients would be almost immediately fatal," said Dr. Lynda Frassetto, associate clinical professor of medicine at the University of California-San Francisco.Adapted from:
Frassetto said that eight of her first nine transplant patients have survived the procedure, one for as long as 18 months. The patient who died, Frassetto told UPI, was infected through blood products used to treat childhood leukemia. He received two liver transplants but died 15 months later of advanced hepatitis. Three patients received livers. Six patients received kidneys. With the exception of one teenager, adults who received organs ranged in age from 38 to 53 at the time of the operation.
In a presentation at the conference, co-sponsored by the American Society of Nephrology and the Amsterdam-based International Society of Nephrology, Frassetto discussed the details of the study. Nine patients who had HIV and stable viral loads thanks to antiretroviral drugs were selected. They were all treated for any other existing disease or condition before undergoing transplant. They received a transplant because they were either next in line on a transplant list, had a family member donor, or agreed to accept organs that were rejected from other institutions, usually because the donor was elderly.
In the patients receiving cyclosporine, the level of CD4-positive cells increased, sometimes markedly. The larger the number of CD4-positive cells, the greater the immune competence. "Fifteen years ago, having HIV infection was an absolute exclusion for receiving a transplant," said Dr. Solomon Smith, a nephrologist and AIDS specialist affiliated with the Veterans Affairs Hospital in Columbia, S.C. "But now, with treatments, we have extended the life expectancy of AIDS patients so that these patients with liver and kidney failure can benefit from these transplants."
Frassetto said that the procedures are still new and are not to be routinely advocated. "Any transplant into an HIV-infected patient should be done as part of an experimental protocol," she said. "This is still a very complicated procedure and requires the help of a lot of specialists in surgery, transplantation, AIDS treatment as well as nephrology."
United Press International
10.15.01; Ed Susman
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.