Kidney Donor’s HIV Strain Found in HIV-Positive Recipient

Strains of HIV from an infected kidney donor showed up in an HIV-positive transplant recipient’s body fluids, as well as the native kidneys.

At this point, however, the finding appears to be just an interesting factoid and not a reason for concern.

Donor-derived HIV sequences were detected in the recipient’s blood and urine up to 16 days after the transplant procedure, reported Mary Klotman, MD, of Duke University Medical Center in Durham, North Carolina, and colleagues.

But while HIV sequences from the donor were detectable in renal cells cultured from the recipient’s urine 12 hours after transplant, renal cells on day 9 only showed the recipient’s strain, they wrote in a “Correspondence” in the New England Journal of Medicine.

The HIV Organ Policy Equity (HOPE) Act means that patients living with HIV can accept HIV-positive donor organs, they noted. And HIV-positive kidney donors have been in the news recently.

Last year, researchers at Johns Hopkins University in Baltimore reported on the case of Nina Martinez, the first living kidney donor with HIV. Surgeons performed a kidney transplant from Martinez to a recipient also living with HIV in March 2019. They noted Martinez’s HIV was well-controlled.

In this case from Klotman and colleagues, the deceased donor was viremic, with an HIV viral load of over 183,000 copies/mL. The recipient, age 61, had polycystic kidney disease and was virally suppressed, with a viral load under 20 copies/mL and on antiretroviral therapy with abacavir, lamivudine, and raltegravir.

Twelve hours after transplant, researchers detected 10 HIV sequences in renal cells cultured from the patient’s urine — four that belonged to the recipient, and six that belonged to the donor. But on day 9, all sequences corresponded to the recipient’s HIV strain.

The authors also noted that at day 42 following transplantation, a “viral blip” of 75 copies/mL was found in the recipient’s plasma, but only the recipient’s strain could be amplified.

Klotman characterized these findings to MedPage Today as “an interesting scientific observation that warrants longitudinal follow-up” to see if the scientific findings correlate to clinical findings. But she emphasized that the report “doesn’t provide any evidence of negative implications for patients” when compared to the benefit of a transplant.

The authors urged long-term follow-up to measure “the effect of renal HIV infection on long-term allograft function,” but Klotman said there’s no evidence this affects the functioning of the transplant.

“Our observation suggests that [recipients] should be followed, but I wouldn’t make any decision about turning down a transplant because there might be a potential [HIV] mutation in the donor. There’s no evidence to suggest that’s a consequence,” she noted.