Johns Hopkins Conducts First Ever Living Donor HIV-to-HIV Kidney Transplant

A team of doctors at Johns Hopkins has completed the first ever living donor HIV-positive to HIV-positive kidney transplant.

The surgery, performed Monday, March 25, is a monumental step in the field of HIV research and adds to the body of evidence showing that a diagnosis is no longer a death sentence. Quite the opposite, in fact.

“Society perceives me and people like me as people who bring death,” Nina Martinez, the 35-year-old donor, told The Washington Post in a pre-operation interview. “And I can’t figure out any better way to show that people like me can bring life.”

Johns Hopkins surgeons, led by Dorry Segev, MD, PhD, professor of surgery and director of the Epidemiology Research Group in Organ Transplantation at Johns Hopkins Medicine, and Christine Durand, MD, associate professor of medicine and oncology at Johns Hopkins, performed the first-of-its-kind transplant after Martinez contacted them and volunteered to undergo testing. Her recipient will remain anonymous.

"I knew I was the one they had been waiting for," Martinez told the media in a telebriefing on Thursday as she was being discharged from the hospital. "For me, [donating my kidney] was an opportunity to be the same as anybody else, particularly since I live in the southern United States where attitudes around HIV are pretty dated. I wanted to do something to jolt people's perceptions. Usually when society thinks of people living with HIV, they think to people from the 1980s. To be able to leave this kind of medical legacy for me was important because I wanted to show that people living with HIV were just as healthy.”

One arm of the surgical team explanted Martinez’s kidney, while another team implanted the organ into the recipient via a 6- to 8-inch incision in the abdomen. The recipient will keep both of their own kidneys, which is standard procedure.

"For us, this is not only a celebration of transplantation, but a celebration of the progress of HIV care and the fact that 30 years ago what was a disease that was basically a death sentence has been so transformed that somebody with HIV can save somebody else’s life," Segev told reporters in the briefing.

Both the living donor and the recipient will continue on antiretroviral therapy and will be monitored vigilantly for signs of resistance. The recipient will take medication to prevent organ rejection.

Martinez reportedly acquired HIV via a blood transfusion at 6 weeks of age, though she wasn’t diagnosed until she was 8 years old in the early ’90s. Prior to the transplant surgery, she was in good physical health with undetectable viral loads.

Just 6 years ago, this procedure would not have been possible because people with HIV were not legally allowed to donate organs.

But that changed in 2013 when the HIV Organ Policy Equity Act (HOPE) was signed into law, allowing HIV-positive individuals to receive transplants from HIV-positive donors. In all HOPE transplants performed up until now, though, the donors been deceased.

In 2016, the team at Johns Hopkins received approval from the United Network for Organ Sharing and successfully conduct the first ever HIV-to-HIV liver transplant and first-in-the-US HIV-to-HIV kidney transplant, using the organs from a dead donor who was HIV-positive.

One concern associated with HIV-positive donors was the possibility of an HIV-negative recipient acquiring the infection through the transplant. The major concern of performing an HIV-to-HIV transplant using a live donor was that the donor on antiretroviral therapy with just 1 kidney would be more susceptible to developing kidney disease.

But previous studies led by Segev, who helped craft the HOPE Act, indicate that long-term mortality is actually consistent with, or lower for live kidney donors than their counterparts in the general public. Furthermore, a 2017 Hopkins study of 42,000 people found that the risk of developing end-stage renal disease among healthy HIV-positive potential donors is not much greater than in HIV-negative individuals.

Johns Hopkins received approval for the live donor HIV-to-HIV kidney transplant in January 2018.

According to the US Department of Health and Human Services, there are currently 113,674 people on the organ transplant waiting list, 94,851 of whom are waiting for a kidney. The success of this transplant now broadens the landscape of potential donors.

“[Nina's] story of courage has really flipped the script for those living with HIV," Durand told the media. "We expect that Nina will have excellent outcomes and the risk of developing kidney disease in the long term is very low. [This] changes the narrative of HIV. Maybe people living with HIV will see this as a breakthrough.”