World First: Mediclinic’s WDGMC Transplants Liver from Live HIV+ Mother to HIV- Child

Posted on 4 October 2018

A living donor liver transplant from an HIV positive mother to her HIV negative child has been successfully performed for the first time at Mediclinic’s Wits Donald Gordon Medical Centre (WDGMC).

This procedure took place in 2017 and the case has been published in the AIDS journal. The transplant received full regulatory and ethics approval from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand. The patient’s details cannot be published as the hospital is obliged to keep the details of the case confidential.

Over one year after the operation, both mother and child are doing well.  Both have recovered from their surgery. According to Prof Jean Botha, Principal Investigator and lead surgeon, Chief of Transplantation at WDGMC, “When the team were deciding whether or not to do this surgery, we asked ourselves many important questions. The main one was ‘What is the risk of the child getting HIV from this transplant?’ Because this was the first transplant of its kind, we couldn’t answer this question to any level of satisfaction. At the moment, we are unsure whether the child has got HIV or not”. In the weeks after the transplant, the team thought that the child was HIV positive.  However, in collaboration with HIV experts at the National Institute for Communicable Diseases (NICD) they were able to access specialised testing.  The NICD has not been able to find any active HIV infection in the bloodstream of the child. This means there may be a chance that the child is HIV negative.

Prof Caroline Tiemessen, HIV researcher at the NICD, explains, “At the moment, we are developing new methods for testing the child, and we hope to be able to have a definitive answer to the question of seroconversion in future. For now, the child will remain on antiretroviral therapy until we have a more comprehensive picture. We have formalised this procedure as a research programme, and as we offer this type of transplantation to more children, we hope to be able to draw more definitive conclusions.”

Dr Harriet Etheredge, Medical Bioethicist on the project, highlights some of the issues the team faced:  “In order to ensure that minimal risk is posed to donors and recipients, this type of transplant is only offered under exceptional circumstances when we really have no other option to save the life of a child. We require full consent from the parents, and we are very careful to ensure that parents are in a position to look after a child who may be infected with HIV”. Extensive efforts are made to identify either a deceased liver donor or an HIV-negative donor for the child before considering an HIV positive parent. Dr Francesca Conradie, HIV Clinician, notes: “When considering an HIV positive parent, it is important that they have an undetectable viral load – this means that they know they are HIV positive and that they have been taking their antiretroviral medication properly for at least six months”. For all these cases, parents are assisted by an Independent Donor Advocate, who helps the parents understand the risks and who is there to provide emotional support throughout the process.

When considering the question of who could access life-saving medical care, Dr June Fabian, Director of Research at WDGMC noted that: “the transplant team are in a position to provide this transplant service to state as well as private, patients in South Africa under an existing relationship between WDGMC and the Gauteng Department of Health. It is hoped that this will also go some way towards promoting justice and equity in liver transplantation in South Africa”.

The transplant team involved in this groundbreaking procedure at WDGMC included Prof Jean Botha – Principal Investigator and lead surgeon, Chief of Transplantation, Dr Francesca Conradie – HIV Medicine, Dr Harriet Etheredge – Ethics and regulatory, Dr June Fabian – Research and Prof Caroline Tiemessen – HIV Research.