Surgeons in Switzerland have accomplished the first-ever liver transplantation between two HIV-positive patients. Both adult men had been treated for their HIV infection with antiretroviral therapy, for many years.
The case, published in the April 2016 edition of the American Journal of Transplantation, details how doctors from Geneva University Hospitals performed the pioneering operation in October 2015, following the recruitment of an organ donor and a receptor in need of a liver.
Fear of organ rejection
Switzerland authorised organ transplantation between HIV-positive individuals in 2007. Eight years were then necessary to prepare for the procedure, and to address the problem of organ rejection by the receptor.
Rejection is a risk in any organ transplant, but immunosuppressive medications – which reduce the strength of the immune system – have proved to be effective anti-rejection drugs in recent years. In the case of HIV patients, however, doctors were concerned that the effects of such medicine would be very harmful. They thought it would further lower their body defences against HIV, worsening the infection and making them more vulnerable to other diseases and infections.
However, HIV patients who take antiretroviral therapy often see their HIV viral load decrease, and they become less vulnerable to getting other diseases. Weakening their immune system by giving them immunosuppressants, as is always the case after any transplant procedure, thus becomes less risky.
In October 2015, when a 75-year-old HIV-positive man died from cerebral haemorrhage after agreeing to give his organs, the transplant of his liver into another HIV-infected man was approved. The operation was a success, but the hospital decided to wait six months to communicate on the results, to see how the patient's health evolved in the long term, and how he tolerated the immunosuppressants. The doctors are now confident that taking these drugs has not led to new diseases appearing or to the HIV infection worsening.
A careful analysis of the donor's and recipient's HIV strains before the operation was also key, to reduce the risk of introducing more aggressive HIV strains into the recipient. "Five months after transplantation, HIV viraemia remains undetectable. This observation supports the inclusion of appropriate HIV-positive donors for transplants specifically allocated to HIV-positive recipients," the authors write.
Switzerland has not been able to enjoy its position as a pioneer for long. In March 2016, American surgeons performed a similar operation with success, opening the way for more interventions of this kind in the near future.