Belal AA, Bourricaudy RA, Saba Z, Ali S, Haddad I, Santos Jr AH. Hope for kidney transplantation in candidates with human immunodeficiency virus. World J Transplant 2026; 16(3): 120869 [DOI: 10.5500/wjt.120869]
Corresponding Author of This Article
Amer A Belal, MD, FASN, Clinical Assistant Professor, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100224, Gainesville, FL 32610, United States. amer.belal@medicine.ufl.edu
Research Domain of This Article
Transplantation
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review-article
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Belal AA, Bourricaudy RA, Saba Z, Ali S, Haddad I, Santos Jr AH. Hope for kidney transplantation in candidates with human immunodeficiency virus. World J Transplant 2026; 16(3): 120869 [DOI: 10.5500/wjt.120869]
World J Transplant. Sep 18, 2026; 16(3): 120869 Published online Sep 18, 2026. doi: 10.5500/wjt.120869
Hope for kidney transplantation in candidates with human immunodeficiency virus
Amer Ashaab Belal, Rafael Aldaya Bourricaudy, Zahra Saba, Saba Ali, Issa Haddad, Alfonso H Santos Jr
Amer Ashaab Belal, Issa Haddad, Alfonso H Santos Jr, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL 32610, United States
Rafael Aldaya Bourricaudy, Zahra Saba, Saba Ali, College of Medicine, University of Florida, Gainesville, FL 32610, United States
Author contributions: Belal AA contributed to leading the original draft; Belal AA, Bourricaudy RA, Saba Z, and Ali S contributed to the writing; Belal AA, Bourricaudy RA, Saba Z, and Ali S contributed to the literature review; Belal AA, Bourricaudy RA, Saba Z, and Ali S; Haddad I and Santos Jr AH contributed to the revision the manuscript; Belal AA and Santos Jr AH contributed to the conception; and all the authors approved of the final version of the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Amer A Belal, MD, FASN, Clinical Assistant Professor, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100224, Gainesville, FL 32610, United States. amer.belal@medicine.ufl.edu
Received: March 11, 2026 Revised: April 20, 2026 Accepted: May 7, 2026 Published online: September 18, 2026 Processing time: 172 Days and 3.3 Hours
Abstract
Kidney transplantation continues to be the kidney replacement therapy of choice for patients with end stage kidney disease (ESKD) associated with a survival benefit over remaining on dialysis. Patients living with both ESKD and human immunodeficiency virus (HIV) have traditionally faced barriers accessing the kidney transplant (KT) waiting list given need for special considerations in addition to general listing requirements for KT candidates. The HIV Organ Policy Equity (HOPE) Act in 2013 and HOPE Act Variance in 2015 restricted HIV positive donor (+D) to HIV positive recipient (+R) transplants to research protocols or Institutional Review Board approved programs. Federal regulatory changes in 2024-2025 removed the above restrictions making HIV +D to HIV +R KTs standard of care practice for approved centers. Removal of the research criteria requirements in alignment with federal regulatory changes will likely expand access so that more individuals living with HIV can obtain a KT. Herein we will provide a narrative review of the available literature in the PubMed database on studies completed under the HOPE act as well as the special considerations in evaluating HIV positive renal transplant candidates and their subsequent post-transplant care to help ensure clinician and patient comfort in this era.
Core Tip: Patients living with both end-stage kidney disease (ESKD) and human immunodeficiency virus (HIV) have faced barriers accessing the kidney transplant waiting list. The HIV Organ Policy Equity (HOPE) act in 2013 and the HOPE act variance in 2015 restricted HIV positive donor (+D) to HIV positive recipient (+R) transplants to research protocols. Federal regulatory changes in 2024-2025 removed the above research restrictions for transplant centers. The evidence supports kidney transplantation as the standard of care for patients living with both ESKD and HIV, and that HIV +D to HIV +R transplantation is non-inferior to the use of donors without HIV for candidates living with HIV.
