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Justifiable transplantation.

In the past, organ transplantation usually has not been recommended in HIV+ people because of the fear that the transplant surgery and necessary immune-suppressive drugs would cause HIV disease to get worse. Also, there were concerns that HIV+ patients would not live long enough to justify the transplant. The widespread use of combination HIV drugs has improved the health of HIV+ patients, but also increased the chance of developing liver and kidney disease as HIV-infected people are living longer. Recently, researchers have begun to reconsider liver, kidney, and heart transplants in HIV+ patients.

One study, published in the journal Transplantation (76:2 p. 370, 2003), reported on 10 patients who received kidney transplants and 4 patients who received liver transplants. All patients had stable HIV disease, good T cell counts, and no history of an opportunistic infection or cancer. All patients who received a kidney transplant survived, while one liver-transplant patient died after complications from hepatitis C co-infection. Organ rejection (when the body's immune system fights the new organ) occurred in half of the kidney-transplant patients but none of the liver-transplant patients. In general, there was no worsening of the HIV following the transplant in patients who took combination HIV therapy.

In addition, a study in The New England Journal of Medicine (348:23, p. 2323, 2003) reported a successful heart transplant in a patient with AIDS and serious heart problems, but who was responding well to HIV therapy. The patient previously had Kaposi's sarcoma (a type of skin cancer that is associated with AIDS) and the chemotherapy used to treat it may have caused the damage to his heart. Two years after the heart transplant, the patient is generally feeling well. However, he has suffered some complications, including anemia (that requires blood transfusions) and frequent episodes of rejection. While these results are promising, organ rejection and co-infection with hepatitis are still major problems in HIV+ transplantation recipients. In addition, there are complex and potentially dangerous interactions between HIV drugs and drugs used to prevent organ rejection. Regardless, these reports show that HIV+ status should not automatically disqualify someone from life-saving organ transplantation.
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Title Annotation:Treatment News
Publication:HIV Treatment: ALERTS!
Date:Oct 1, 2003
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