Mayo Clinic in Florida is now offering kidney and pancreas transplants to HIV positive patients with advanced kidney disease and diabetes. Evidence is now solid that HIV-positive patients have the same favorable outcome in terms of patient and allograft survival as non-HIV positive organ transplant recipients, says Mary Prendergast, M.D., a kidney specialist whose focus is the care of patients who receive kidney and pancreas transplants.
"With the utilization of HAART therapy to control HIV disease, it is very clear that solid organ transplant is both feasible and successful," she says. "We are very excited to be able to offer this service, which will provide end-stage kidney disease patients an alternative to years of difficult dialysis treatment."
Concerns in the past relating to the necessity of utilizing anti-rejection medications to transplant already immunosuppressed HIV-positive patients have been overcome with solid evidence that there is no increase in either the incidence of opportunistic infection or an acceleration of HIV disease, Dr. Prendergast says, as demonstrated in a recent large multi-center U.S.-based study, published last November in The New England Journal of Medicine.
Mayo Clinic in Florida has offered liver transplant for HIV-positive patients for a number of years now Dr. Prendergast says, and currently performs approximately 110 kidney transplants each year, and 10 pancreatic transplants, either alone or in combination, for non-HIV patients. Criteria for transplantation in HIV positive patients include an undetectable viral load and CD4 count greater than 200 cells per cubic millimeter, she says. Patients will be eligible to receive both deceased and living donor transplant organs.
The need for organ transplants is widespread, Dr. Prendergast adds. Currently there are 96,000 patients on the kidney transplant and 1,300 waiting for a pancreas transplant wait lists, according to the United Network for Organ Sharing (UNOS). Between one and three percent of those on dialysis are HIV positive.