For the first time, the heart of an HIV-positive donor has been transplanted into a recipient living with HIV, according to the Montefiore Health System in New York, where the transplant was performed.
Such a transplant was made possible by the passage of the HOPE (HIV Organ Policy Equity) Act in 2013, but it took almost 9 years to see the first successful transplant.
“This is an important milestone for people living with HIV who need a heart transplant,” said Ulrich P. Jorde, MD, section chief for heart failure, heart transplantation and circulatory support. mechanics in Montefiore. Medscape Medical News.
In the United States, between 60,000 and 100,000 people could benefit from a new heart, but only 3,800 transplants have been performed in 2021, so there is great interest in expanding the donor pool. According to case reports, people with HIV have received only a limited number of heart transplants since 2003.
The wait can be very long, Jorde said, and “a lot of times people die because we can’t find a heart.”
The patient underwent a kidney transplant at the same time
According to a press release from Montefiore, the patient was in her 60s, had advanced heart failure, and received the heart and a concurrent kidney transplant in early spring.
“After the four-hour operation, she spent five weeks recovering in hospital and is now seeing her transplant doctors in Montefiore for follow-up,” the announcement reads.
“Several months later, everything seems really good with this heart,” said Jorde.
The transplant is good news for many groups, he said.
HIV-positive patients waiting for their chance for a donor heart may have a better chance of getting a heart quickly since donor hearts from HIV-positive patients can only go to HIV-positive patients and only to those on the center list who participate in the HOPE law.
Listed people who do not have HIV also benefit in cases where a listed HIV-positive person receives a heart and is removed from the list.
People living with HIV who wish to become organ donors can know that if their heart is donated, it could save a life and inspire others to donate.
“It’s a win-win situation for everyone,” Jorde said.
Strict eligibility requirements
To meet the eligibility criteria, recipients’ HIV must be fully controlled, Jorde said. The virus must be undetectable and the recipient must also meet the criteria for heart transplantation. Voluntary recipients are placed on the general heart transplant waiting list.
“It was done for a liver and kidney transplant. It was never done for a heart transplant patient,” Jorde said.
The reason innovation came later for hearts, he said, is that the margin for error with heart transplantation is extremely narrow.
“If you have a heart transplant and you have severe rejection, you can die. If you have a kidney transplant and you have severe rejection, you go back on dialysis,” he explained.
You also have to have the right patient, he noted.
The patient must be willing to take the risk of being part of something that has never been done and have exceptional trust in their doctor.
“The real pioneer and the real hero here, it’s not me, not the surgeon who put it in, it’s the patient. The patient said, ‘I want to live. I trust you. I’m ready to take that risk’.” says Jorde.
Trust has grown over the years
Confidence in transplanting an HIV-positive heart to an HIV-positive recipient has grown over the years. There is long-term evidence of success with HIV-positive liver and kidney donors, and there have been improvements in drugs to suppress HIV.
Julie Doberne, MD, PhD, from the Department of Cardiovascular and Thoracic Surgery at Duke University, Durham, North Carolina, studied heart transplant survival outcomes for HIV-positive recipients compared to outcomes for HIV-negative recipients .
She said of the announcement, “This is a significant advancement in the areas of organ transplantation, HIV care and advanced heart failure. Heart transplantation remains the gold standard for the treatment of end-stage heart failure. Hundreds of people with heart failure die each year. waiting for a heart.
“Research of the abdominal transplant literature shows that transplantation from an HIV-positive donor to an HIV-positive recipient is safe, and this first HIV-positive donor to an HIV-positive cardiac recipient may herald an increase in the availability of organs for patients suffering from heart failure living with HIV in the future,” she said.
However, she said she would not expect a sudden increase in these transplants.
She pointed out that “there are stringent stipulations in the HOPE Act that restrict heart transplant centers from participating in organ transplants from HIV-positive donors.”
One of the criteria, she says, is the number of transplants the center has performed in which the donor is HIV-negative and the recipient is HIV-positive.
“Because very few centers have sufficient volume to meet this requirement, only two centers in the United States [Montefiore and New York-Prebsyterian/Columbia] are currently authorized to register patients for HIV-positive donor/HIV-recipient heart transplantation. It’s a long process to become qualified.”
Jorde and Doberne did not disclose any relevant financial relationship.
Marcia Frellick is a Chicago-based freelance journalist. She has previously written for the Chicago Tribune, Science News and Nurse.com, and served as an editor for the Chicago Sun-Times, the Cincinnati Enquirer and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.
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