HJAR Sep/Oct 2021

58 SEP / OCT 2021  I  HEALTHCARE JOURNAL OF ARKANSAS Hospital Rounds UAMS Performs State’s First HIV-to-HIV Kidney Transplant The University of Arkansas for Medical Sci- ences (UAMS) has performed the first transplant in Arkansas from an HIV-positive donor to an HIV- positive recipient. The successful kidney transplant from a deceased person who had the human immuno- deficiency virus was performed in May by Emma- nouil Giorgakis, MD, a transplant surgeon in the UAMS College of Medicine. It was performed as part of a national clinical trial, led and sponsored by Johns Hopkins Hos- pital in Baltimore, which was made possible by the HIV Organ Policy Equity (HOPE) Act that Con- gress passed in 2013. The law permits transplant teams in the United States with an approved research protocol to transplant organs from com- patible HIV-positive donors into eligible HIV-pos- itive recipients enlisted for a transplant, who have consented to participate in the study. HIV is a virus that, if left untreated, causes acquired immune deficiency syndrome (AIDS), a medical condition that leaves the body defense- less against opportunistic infections. However, improvements in antiretroviral treatments over the years have allowed people with HIV to live normal life spans. UAMS is one of 27 transplant centers nation- wide that are taking part in the HOPE in Action clinical trial of deceased HIV-positive donor kidney transplants to HIV-positive recipients. This multi- center pilot study evaluates the safety of HIV-pos- itive deceased donor kidney transplants in HIV- positive recipients. UAMS, which operates the only adult liver and kidney transplant program in Arkansas, is also one of the 17 U.S. transplant centers participating in the HOPE in Action trial of HIV-positive deceased donor liver transplants for HIV-positive recipients. Stable HIV-positive adult liver or kidney trans- plant candidates are currently being offered enrollment in the clinical trial study at UAMS. “There are over 120,000 patients on the waiting list for a kidney in the United States, and about 10,000 of those are HIV-positive patients,” Gior- gakis said. “HIV-positive patients have a higher risk of kidney failure and carry a three-fold risk of death while on dialysis compared to their HIV-neg- ative counterparts.” “If we could use organs from HIV-positive donors, there would be an estimated 1,000 more available grafts each year,” Giorgakis said. Although enacted in 2013, the HOPE Act didn’t become effective until November 2015, following the development and publication of research cri- teria for HIV-positive organ donations to HIV-pos- itive recipients. The first deceased donor HOPE transplants in the United States took place in 2016. So far, Giorgakis said, there have been 100 HIV- to-HIV kidney transplants performed nationwide through the clinical trial, including the May 3 trans- plant that immediately allowed Richard Poston, 46, to stop the dialysis treatments he had been receiving three times a week for about three years. He was diagnosed with HIV in 2011 after devel- oping cryptococcal meningitis, an inflammation of the brain and spinal cord membranes. The infec- tion attacked his optic nerve, causing total blind- ness. Then in 2018, he started feeling dizzy and disoriented, “like someone had spun me around,” and suddenly needed the assistance of a cane to walk. A trip to the emergency room led to a diag- nosis that he was in kidney failure, and the dialy- sis treatments began. Poston said he had no qualms about receiving a kidney from an HIV-positive donor, “because I knew I needed a kidney, and I knew that when you get an organ, the doctors have really looked it over” to make sure it’s appropriate for the recipient. A month after the transplant, he said he no lon- ger experiences the dizziness that was making it hard for him to function. “It’s changed my life,” he said. “He’s doing very well,” Giorgakis agreed. The donated kidneys offered in the national trial are typically retrieved from “otherwise healthy donors with excellent kidney function who also happen to have HIV,” the surgeon said. “In this multicenter pilot study, so far, overall transplant and HIV outcomes have been excellent, with no HIV breakthrough attributable to receiv- ing an HIV-positive donor kidney,” Giorgakis said. “We have a high prevalence of HIV in the South, which means we have a relatively high number of HIV-positive patients with renal failure, and there- fore in need of a lifesaving transplant,” he said. UAMS’ kidney and liver transplant programs have both received high national rankings from the Scientific Registry of Transplant Patients, which evaluates the status of the nation’s solid organ transplant system. UAMS Physicians See Dramatic Increase in PostpartumPsychosis Cases During Pandemic Postpartum psychosis is a serious, albeit rare illness, compared to the number of postpartum depression cases seen in the United States. The Women’s Mental Health Program at the Uni- versity of Arkansas for Medical Sciences (UAMS), on average, treats two cases of the illness a year. That’s why Jessica Coker, MD, the medical direc- tor of the Psychiatric Research Institute’s women’s inpatient unit, became alarmed when she saw a growing number of cases during the COVID- 19 pandemic. Between March 2020 and Febru- ary 2021, Coker and her team saw a total of nine cases of postpartum psychosis, which can develop within four weeks of giving birth and can include feelings of paranoia or irritability, hallucinations and hyperactivity. UAMS delivers between 2,500 and 3,000 new- borns every year, according to Coker. Nationally, approximately 150 out of 1,000 will experience postpartum depression; postpartum psychosis affects one out of 1,000 mothers, on average. “It is very recognizable when present. The patients are typically very, very ill,” said Coker. “Family members see it first usually. They’re not sleeping, paranoid and can be very irritable.” When Coker and Erin Bider, MD, a fourth-year resident in the UAMS College of Medicine’s Department of Psychiatry, recognized the dra- matic increase in postpartum psychosis statistics, they began to review five years of patient records in an effort to determine if such a spike in cases was out of the ordinary. Of the nine patients seen by the Women’s Men- tal Health Program, eight required inpatient psy- chiatric hospitalization due to the severity of their symptoms, with another seen on an outpatient basis. Three of these cases tested positive for COVID-19 prior to the onset of psychosis, but all were asymptomatic for the respiratory illness. “We can safely say that the pandemic was asso- ciated with a higher risk for postpartum psycho- sis,” said Bider, who, along with Coker, authored a paper that was published in the Archives of