Transplanting Organs from Donors with HIV or Hepatitis C: The Viral Frontier

Abstract

A wide gap between the increasing demand for organs and the limited supply leads to immeasurable loss of life each year. The organ shortage could be attenuated by donors with human immunodeficiency virus (HIV) or hepatitis C virus (HCV). The transplantation of organs from HIV+ deceased donors into HIV+ individuals (HIV D+ /R+) was initiated in South Africa in 2010; however, this practice was forbidden in the USA until the HIV Organ Policy Equity (HOPE) Act in 2013. HIV D+/R+ transplantation is now practiced in the USA as part of ongoing research studies, helping to reduce waiting times for all patients on the waitlist. The introduction of direct acting antivirals for HCV has revolutionized the utilization of donors with HCV for HCV-uninfected (HCV−) recipients. This is particularly relevant as the HCV donor pool has increased substantially in the context of the rise in deaths related to drug overdose from injection drug use. This article serves to review the current literature on using organs from donors with HIV or HCV.

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Abbreviations

HIV:

Human immunodeficiency virus

HCV:

Hepatitis C virus

HOPE:

HIV Organ Policy Equity Act

US:

United States

DAA:

Direct acting antiviral

ART:

Antiretroviral therapy

OI:

Opportunistic infection

OPO:

Organ procurement organization

FP:

False positive

Ab:

Antibody

Ag:

Antigen

CIT:

Cold ischemia time

KDPI:

Kidney donor profile index

ATG:

Antithymocyte globulin

CMV:

Cytomegalovirus

DGF:

Delayed graft function

IRD:

Infectious risk donor

SVR:

Sustained virologic response

AASLD:

American Association for the Study of Liver Diseases

IRB:

Institutional review board

IDSA:

Infectious Diseases Society of America

CKD:

Chronic kidney disease

SRTR:

Scientific Registry of Transplant Recipients

KT:

Kidney transplantation

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Acknowledgements

This work was supported by grant number F32DK124941 (Boyarsky) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), fellowship number 90088546 (Strauss) from Pearl M. Stetler Fellowship and K24AI144954 (Segev) from National Institute of Allergy and Infectious Diseases (NIAID). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government.

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Correspondence to Dorry L. Segev.

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Boyarsky, B.J., Strauss, A.T. & Segev, D.L. Transplanting Organs from Donors with HIV or Hepatitis C: The Viral Frontier. World J Surg (2021). https://doi.org/10.1007/s00268-020-05924-1

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