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Key Clinical, Ethical, and Policy Issues in the Evaluation of the Safety and Effectiveness of Solid Organ Transplantation in HIV-Infected Patients
Arch Intern Med. 2003;163:1773-1778.
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INTRODUCTION
PATIENTS WITH human immunodeficiency virus (HIV) infection are at significant risk for end-stage kidney and liver disease, and are therefore potential candidates for solid organ transplantation.1-15 However, they have been considered poor transplant candidates. In this era of effective antiretroviral therapy, preliminary experience with transplantation appears promising, although critical clinical and ethical questions remain. Thus, it is timely to perform a safety and efficacy study of transplantation in HIV-infected patients. Key clinical issues in the design of such a study include consideration of the patients' history of opportunistic complications and hepatitis C coinfection, and their ability to tolerate antiretroviral drugs when defining selection criteria for study subjects. The ethical questions of resource allocation and the risks and benefits associated with living and cadaveric organ donation must also be carefully considered. To address the concerns of utility and effectiveness for each intervention, the minimum acceptable patient and graft survival rates must . . . [Full Text of this Article]
RESOURCE ISSUES
RISKS AND BENEFITS OF DIFFERENT DONOR POOLS
STUDY SUBJECT SELECTION CRITERIA
Example 1: History of Opportunistic Infections Example 2: Plasma HIV RNA and Liver Transplantation Example 3: Hepatitis C and Liver Transplantation Example 4: Hepatitis C and Kidney Transplantation
REIMBURSEMENT POLICIES
OFF-STUDY TRANSPLANT OPTIONS
CONCLUSIONS
Michelle E. Roland, MD
Positive Health Program
Department of Medicine
University of California, San Francisco
Ward 84, San Francisco General Hospital
995 Potrero Ave
San Francisco, CA 94110
(e-mail: mroland@php.ucsf.edu)
Bernard Lo, MD;
Jeffrey Braff, DrPH
Berkeley, Calif
Peter G. Stock, MD, PhD
San Francisco
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Human Immunodeficiency Virus Infection and Kidney Transplantation in the Era of Highly Active Antiretroviral Therapy and Modern Immunosuppression
Abbott et al.
J. Am. Soc. Nephrol. 2004;15:1633-1639.
ABSTRACT
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