Detection of donor’s HIV strain in HIV-positive kidney-transplant recipient

  • Heather Mason
  • Medical News
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The HIV Organ Policy Equity (HOPE) Act allows persons living with HIV infection to accept HIV-positive donor organs.

This case study reported a 61-year-old recipient with polycystic kidney disease with a suppressed viral load and normal CD4+ count, who was receiving antiretroviral therapy. The transplanted kidney was from a deceased HIV-positive donor with a viral load of 183,326 copies per millilitre (ml). Viral sequencing from the urine and peripheral blood samples, from both the donor and recipient and a biopsy of the donor kidney, was performed.

Donor-derived HIV sequences were amplified from urine and blood samples from the recipient up to 16 days after transplantation but were undetectable at later time points.

HIV envelope sequences were amplified from renal epithelial cells cultured from the recipient’s urine both before and after transplantation, at 12 hours and 9 days. The 12-hour sample contained 10 sequences, 4 of which corresponded to the recipient’s strain and 6 to the donor strain. At 9 days, 6 sequences were derived from the renal cells and all corresponded to the recipient’s strain.

The HIV strains of both the donor and the recipient were susceptible to the antiretroviral therapy regimen that the recipient was receiving.

A viral blip (75 copies/ml), 42 days after transplantation revealed that only the viral strain from the recipient could be amplified.

Key points:

  • Presence of infection in renal epithelial cells in both the native kidneys (which were not removed) and the transplanted kidney.
  • Renal cell-derived sequences were closely related to those amplified from urinary cell-free RNA, supporting the role of renal epithelial cells as a source of viruses.
  • Longitudinal samples will provide important insights into viral dynamics.
  • HIV infection of renal epithelial cells could affect long-term allograft survival.