Long-Term Outcome of Liver Transplantation in HIV-1-Positive Patients: 15-Year Follow-Up

Shinji Yamamoto,Bo-Göran Ericzon,Antti Oksanen,Annika Wernerson,Gunnar Söderdahl,Ola Weiland,Anders Sönnerborg,Robert Schwarcz

doi:10.5402/2013/480582

Abstract

Liver transplantation (LT) for patients with human immunodeficiency virus type-1 (HIV-1) infection has been associated with poor outcome. However, after the introduction of the highly active antiretroviral therapy, short-term patient survival after LT has improved significantly. We examined the long-term outcome of HIV-1-positive patients who underwent LT. Medical records were analysed in nine HIV-1-positive LT patients who underwent LT from August 1998 to May 2012. Eight were known to be HIV-1 positive at the time of listing for LT and had end-stage liver disease (ESLD) due to hepatitis C. One patient had primary biliary cirrhosis, and primary HIV-1 infection was found at the date of LT. Seven of the nine patients remain alive to date. So far, three have survived more than 12 years after LT. The overall patient survival rate for both five and 10 years is 77.8%. Four patients experienced acute rejection and six acquired biopsy-confirmed HCV recurrence. HIV-1 replication was effectively blocked during follow-up in all patients. We conclude that long-term survival of HIV-1-positive patients after LT can be achieved. Our study suggests that LT can offer an effective treatment option in selected HIV-1 infected patients with ESLD.

Highlights

Orthotopic liver transplantation (LT) is an established treatment modality for patients with end-stage liver disease (ESLD), liver malignancy with certain conditions, and some metabolic liver disorders
HIV infection has generally been regarded as a contraindication for LT or at least experimental in the pre-highly active antiretroviral therapy (HAART) era
In our previous report on short-term outcome in HIV-infected patients after LT, we found that the replication of human immunodeficiency virus type 1 (HIV-1) could effectively be inhibited with the antiretroviral therapy and that undetectable plasma HIV RNA levels were achieved in the majority of our patients

Summary

Introduction

Orthotopic liver transplantation (LT) is an established treatment modality for patients with end-stage liver disease (ESLD), liver malignancy with certain conditions, and some metabolic liver disorders. The short- and long-term graft and patient survival have been improved with the refinement of transplant indications, modification of surgical techniques, and postoperative management with new immunosuppressive protocols [1]. LT for ESLD in patients with human immunodeficiency virus type 1 (HIV-1) infection has been controversial and has previously been regarded as an absolute contraindication in some transplantation centres. This was due to early reports indicating poor outcome after LT in HIV-1 infected patients at the time of LT or acquired HIV at or soon after LT [2].

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Conclusion