TY - JOUR
T1 - Living Kidney Donation in Individuals with Hepatitis C and HIV Infection
T2 - Rationale and Emerging Evidence
AU - Liyanage, Luckmini
AU - Muzaale, Abimereki D.
AU - Henderson, Macey L.
AU - Durand, Christine M.
N1 - Funding Information:
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.
Publisher Copyright:
© 2019, Springer Nature Switzerland AG.
PY - 2019/6/15
Y1 - 2019/6/15
N2 - 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.
AB - 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.
KW - Direct-acting antivirals
KW - HIV
KW - HIV Organ Policy Equity Act
KW - Hepatitis C
KW - Living donor
KW - Living-donor transplantation
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U2 - 10.1007/s40472-019-00242-5
DO - 10.1007/s40472-019-00242-5
M3 - Review article
C2 - 32855901
AN - SCOPUS:85090087382
SN - 2196-3029
VL - 6
SP - 167
EP - 176
JO - Current Transplantation Reports
JF - Current Transplantation Reports
IS - 2
ER -