Transplant patient breaks new ground

Posted on 23 Oct 2009 at 8:35pm
By David Taffet | Staff Writer taffet@dallasvoice.com

Dr. Nick Bellos oversees first local kidney transplant for HIV-positive patient; man waited 6 years for new organ he was told he’d never have

GETTING IT DONE | Dr. Nick Bellos had consulted with the University of California — San Francisco on getting transplants for HIV-positive patients, and was able to get one of his patients on the kidney transplant list at Methodist Hospital in Dallas, even though no HIV-positive patient in Dallas had previously been approved for such a surgery. (DAVID?TAFFET/Dallas Voice)

In July, one of Dr. Nick Bellos’ patients became the first person with HIV in Dallas — possibly in Texas — to undergo kidney transplant surgery.

Bellos, an Oak Lawn-based infectious disease specialist, has worked with persons with HIV/AIDS since 1981.

Before the 1997 introduction of the three-drug cocktail to treat HIV, people with the virus were not expected to survive long-term. Because of that, transplants were not considered an option for persons living with AIDS.

Now, despite increases in expected life span, acceptance of HIV-positive candidates into transplant programs continues to be slow.

Bellos’ 40-year-old patient, who asked not to be identified by name, said he first learned of his HIV status six years ago when his kidneys began to fail.

“Originally, I was told there is no transplant for anyone with HIV,” he said. So he began dialysis in 2003 for what he was told would be the rest of his life.

While he faithfully kept his dialysis appointments, he didn’t accept the idea that he could never have a transplant.

He said he learned through the Internet that hospitals in the North were performing such transplants and began searching for a local hospital that would put him on its waiting list. He was accepted by a program in San Antonio, and he remained on that list for more than three years.

He continued working for awhile, but his dialysis treatments made it more and more difficult to stay on the job. Finally, in 2006, he went on disability and was referred from Parkland Hospital’s Amelia Court clinic to Bellos.

Bellos said he has several patients who needed liver transplants that he coordinated with University of California San Francisco. In this case, he was able to gain entrance to a local transplant program at Methodist Hospital.

Even though he had been listed for several years in a separate program, Bellos’ patient had to start the process all over again at Methodist Hospital.

To qualify for the list, Bellos said the patient had to be on a stable regimen of HIV drug therapy for six months. In considering who will be given an available organ, he said, the transplant center monitors whether the candidate keeps dialysis appointments regularly.

In addition, the patient’s heart must be stable, their viral load should be undetectable for six months and their T cell count has to be over 200.
This patient had a T cell count over 900.

After guaranteeing that his condition was stable for six months, Methodist Hospital put him on their waiting list for a new kidney.

The patient said he had to undergo a session with a psychiatrist to demonstrate that he could deal with the transplant emotionally, and he had to show that he had a support network to help him after the operation.

Every six months he spent on the waiting list, he had to have another therapy session to make sure he was still mentally fit for the operation.

With a very limited number of organs available for transplant, Bellos explained, the hospital must make sure that they are given to the candidates most likely to recover short-term and benefit long-term.

One day in July, Bellos said, “I got a call that morning that they were doing the matching and if it matched,” they would transplant that evening. The antigen matching was very close and the operation occurred that day.

The patient said that by the next morning he was passing urine, a good indication of the acceptance of the graft.

After a transplant, a patient is normally treated with anti-rejection medication. Bellos said that the immunologist at Methodist Hospital who works as an integral part of the transplant team had no experience with the interaction between the HIV medication and the transplant drugs.

To monitor the medication, the team relied on Bellos, who had gained experience from working with UCSF on his patients who received livers.

“We don’t use one of the [transplant] drugs because it knocks out T cells,” Bellos said, referring to the anti-rejection medications, “But we do use others and dosing intervals can be prolonged based on the HIV meds.”

Bellos said, “The five-year survival rate is higher” among people with HIV, probably because of the already suppressed immune system, but the initial risk of rejection also seems to be higher.

Those figures are anecdotal, though, because the first study of organ transplants to HIV-positive patients is still under way. That study is following patients from 20 transplant centers around the country but none in Texas.

With the success of the first kidney transplant into someone with HIV in Dallas, Bellos said other patients are at various stages in the process of becoming candidates to receive new organs.

Bellos said, “We have 10 to 15 that we’re following now.”

The need hasn’t suddenly increased, but with their first success, the transplant center at Methodist Hospital is now willing to consider other people with HIV.
The patient spent a week in the hospital. He said that after six years of dialysis, one of the hardest things to do was to train himself to go to the bathroom again.

He said, “I feel better. My level of energy is up. People tell me how much better I look. My Friday nights are free.”

Friday had been one of his three weekly dialysis treatments.

For a month after surgery, the patient had weekly appointments with Bellos as well as at the transplant center, where they are following this breakthrough surgery closely. Those weekly visits are now biweekly and Bellos said he expects them to drop to monthly soon.

The patient said he does some exercise now and is careful about what he eats. His favorite drink is water, which he had to limit while on dialysis.

“There were goals in my life that I had not ruled out but wondered how I could do that and go to dialysis. A whole new set of goals have opened up for me,” he said.

To pursue those dreams, he has returned to school. Currently studying psychology and Spanish, he said he wants to go to graduate school and plans to become a teacher.

Bellos said the apparently successful transplant surgery says a lot about the evolution of HIV treatment: “Going from having nothing to treat someone with in 1981 to doing transplants …”

And his patient is grateful for this renewed life he has been given. While he was not allowed to contact the family of the donor directly, he was able to write them a letter through the transplant center to thank them for giving him the gift of life.

This article appeared in the Dallas Voice print edition October 23, 2009.

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