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Living Kidney Donation in Individuals with Hepatitis C and HIV Infection: Rationale and Emerging Evidence

  • Live Kidney Donation (K Lentine and R Schaffer, Section Editors)
  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

HIV-infected (HIV+) and hepatitis C virus-infected (HCV+) individuals with end-stage renal disease (ESRD) have decreased access to kidney transplantation. With new opportunities provided by the HIV Organ Policy Equity (HOPE) Act and direct-acting antivirals (DAAs) for HCV, we explore the potential risks and benefits of living-donor kidney transplantation from HIV+ or HCV+ donors from the perspective of both donor health and recipient outcomes.

Recent Findings

The HOPE Act permits organ donation from both deceased and living HIV+ persons to HIV+ recipients; however, there is only a clinical experience with HIV+ deceased donors to date. Empirical evidence demonstrates a low but acceptable risk of ESRD in potential HIV+ living donors without comorbidities who have well-controlled infection in the absence of donation. With the availability of potent DAAs for eradication of HCV infection, growing evidence shows good outcomes with HCV-seropositive and/or -viremic deceased kidney donors providing rationale to consider HCV+ living donors.

Summary

HIV+ and HCV+ living-donor kidney transplantations may improve access to transplant for vulnerable ESRD populations. Careful evaluation and monitoring are warranted to mitigate potential risks to donors and recipients.

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Acknowledgements

This work was supported in part from the National Cancer Institute (Durand, K23CA177321-01A1) and National Institute of Diabetes and Digestive and Kidney Diseases (Segev, K24DK101828 and R01AI120938) and the JHU Center for AIDS Research 1P30AI094189.

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Authors and Affiliations

  1. Department of Medicine and Oncology, Johns Hopkins University School of Medicine, 725 North Wolfe Street/PCTB Room 228, Baltimore, MD, 21205, USA

    Luckmini Liyanage & Christine M. Durand

  2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Abimereki D. Muzaale & Macey L. Henderson

  3. Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Christine M. Durand

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  1. Luckmini Liyanage
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Correspondence to Christine M. Durand.

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Macey Henderson is a member of the OPTN/UNOS board of directors.

Luckmini Liyanage, Abimereki D. Muzaale, and Christine M. Durand declare no conflict of interest.

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Liyanage, L., Muzaale, A.D., Henderson, M.L. et al. Living Kidney Donation in Individuals with Hepatitis C and HIV Infection: Rationale and Emerging Evidence. Curr Transpl Rep 6, 167–176 (2019). https://doi.org/10.1007/s40472-019-00242-5

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