Page 66 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Guideline

Southern African HIV Clinicians Society guidelines for

solid organ transplantation in human immunodeficiency

virus: An evidence-based framework for human

immunodeficiency virus-positive donors and recipients

Authors: Introduction
Jeremy S. Nel 1
Francesca Conradie 2,3,4 These guidelines, intended for transplantation healthcare practitioners in Southern Africa, seek to
Jean Botha sketch an evidence-based framework for human immunodeficiency virus (HIV)-positive donors
5
Harriet Etheredge 5 and recipients regarding solid organ transplantation. The guidelines include considerations for
June Fabian the transplantation of organs from HIV-positive donors to HIV-negative recipients. Donor and
5,6
4,7
Leon Levin recipient eligibility, HIV transmission risks and ethical considerations are discussed.
Ahmad H. Mazanderani
8
Michelle Moorhouse
9
1
Elmi Muller 10,11 South Africa has over 7 million people living with HIV, the largest such population in the world.
Caroline Tiemessen 6,8,12 Approximately 20% of people aged 15–64 years are living with HIV in South Africa. Compared
2
David Thomson 10,11 with HIV-negative controls, people living with HIV are at increased risk of end-stage organ
Julia Turner
13
disease. Human immunodeficiency virus-positive patients demonstrate a faster decline in renal
Affiliations: function than HIV-negative patients, and an approximately threefold increased risk of end-stage
1 Helen Joseph Hospital, renal disease. 3,4,5 Furthermore, people living with HIV have a higher risk of acute and chronic liver
Department of Medicine, failure, accelerated progression of hepatitis B and C co-infection to cirrhosis, and an increased risk
University of the of hepatocellular carcinoma compared with HIV-negative controls. 6,7,8 The increased risk posed by
Witwatersrand, HIV is multifactorial, with direct HIV toxicities, opportunistic infections, chronic systemic
Johannesburg, South Africa
inflammation, immune dysfunction, antiretroviral therapy (ART) side-effects and genetic factors
2 Clinical HIV Research Unit, all potentially playing synergistic, contributory roles. 9,10
Wits Health Consortium,
Johannesburg, South Africa In many cases of end-stage renal or liver disease, organ transplantation may offer definitive cure
of the underlying condition, with a resultant reduction in mortality. However, there is a critical
3 Department of Medicine, shortage of available organs. Although thousands of South Africans are waitlisted for
University of the
Witwatersrand, Johannesburg, transplantation, only approximately 500 solid organ and corneal transplantations are performed
11
South Africa each year. The number of transplantations performed in South Africa has declined over the past
decade. 11,12 A prolonged waiting period prior to organ transplantation adds substantial financial,
4 Helen Joseph Hospital, morbidity and mortality costs to the patients concerned and to the healthcare sector as a whole.
Johannesburg, South Africa
One reason for the shortage of available organs is that potential donors may be excluded if they
5 Wits Donald Gordon Medical
Centre, Johannesburg, are HIV-positive, particularly for living donors. Historically, there has been considerable concern
South Africa about the transmission of HIV and other opportunistic infections from the donor to the recipient,
as well as concerns about graft viability. The high prevalence of HIV within the South African
6 Faculty of Health Sciences, population, particularly in persons aged < 65 years, means that a large pool of potential donors
University of Witwatersrand, may be unlocked if it is possible to utilise organs from this group safely for transplantation.
Johannesburg, South Africa
On the recipient side, it has only recently become understood that HIV-positive patients can make
7 Right to Care, NGO,
Johannesburg, South Africa suitable recipients of solid organ transplants because of groundbreaking work both locally and
internationally. These guidelines seek to provide best practice recommendations for considering
8 Centre for HIV and STIs,
National Institute for 9 Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
Communicable Diseases, 10 Department of Medicine, University of Cape Town, Cape Town, South Africa
National Health Laboratory 11 Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
Service, Johannesburg, 12 DST/NRF Chair of HIV Vaccine Translational Research, Pretoria, South Africa
South Africa 13 Right to Care NGO, Centurion, South Africa
Corresponding author: Jeremy Nel, [email protected]
Read online: Dates: Received: 20 July 2020|Accepted: 31 July 2020|Published: 15 Oct. 2020
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Scan this QR How to cite this article: Nel JS, Conradie F, Botha J, et al. Southern African HIV Clinicians Society guidelines for solid organ transplantation
in human immunodeficiency virus: An evidence-based framework for human immunodeficiency virus-positive donors and recipients.
code with your S Afr J HIV Med. 2020;21(1), a1133. https://doi.org/10.4102/sajhivmed.v21i1.1133
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to read online. Note: For the purposes of this guideline, the term ‘HIV positive’ was used in place of the journal’s preferred term, ‘people living with HIV’,
in order to avoid confusion with other terms specific to organ transplants, such as ‘living donors’ and ‘deceased donors’.
http://www.sajhivmed.org.za 58 Open Access