Abstract
Objectives. This summary evaluates the outcomes of orthotopic liver transplantation (OLT) of HIV-positive patients in Germany. Methods. Retrospective chart analysis of HIV-positive patients, who had been liver-transplanted in Germany between July 1997 and July 2011. Results. 38 transplantations were performed in 32 patients at 9 German transplant centres. The reasons for OLT were end-stage liver disease (ESLD) and/or liver failure due to hepatitis C (HCV) (n = 19), hepatitis B (HBV) (n = 10), multiple viral infections of the liver (n = 2) and Budd-Chiari-Syndrome. In July 2011 19/32 (60%) of the transplanted patients were still alive with a median survival of 61 months (IQR (interquartile range): 41–86 months). 6 patients had died in the early post-transplantation period from septicaemia (n = 4), primary graft dysfunction (n = 1), and intrathoracal hemorrhage (n = 1). Later on 7 patients had died from septicaemia (n = 2), delayed graft failure (n = 2), recurrent HCC (n = 2), and renal failure (n = 1). Recurrent HBV infection was efficiently prevented in 11/12 patients; HCV reinfection occurred in all patients and contributed considerably to the overall mortality. Conclusions. Overall OLT is a feasible approach in HIV-infected patients with acceptable survival rates in Germany. Reinfection with HCV still remains a major clinical challenge in HIV/HCV coinfection after OLT.
Highlights
The introduction of highly active antiretroviral therapy (HAART) in 1996 has enabled the control of humanimmunodeficiency-virus (HIV)-infection in most patients and resulted in a marked decrease in opportunistic infections and an increase in life expectancy [1, 2]
End-stage liver disease has become a prominent problem in these patients, and the demand for liver transplantation is increasing
The model for end-stage liver disease (MELD) score [11], which has been used for organ allocation since December 2006, was calculated as a marker of liver disease severity
Summary
The introduction of highly active antiretroviral therapy (HAART) in 1996 has enabled the control of humanimmunodeficiency-virus (HIV)-infection in most patients and resulted in a marked decrease in opportunistic infections and an increase in life expectancy [1, 2]. Since HIV has become a chronic disease, comorbidities are of increasing clinical importance. Among HIV-infected patients in Germany HCV coinfection rates range between 10 and 15% [3], and the prevalence of HBV surface antigen (HBs-Ag) is estimated to be 10% [4]. End-stage liver disease has become a prominent problem in these patients, and the demand for liver transplantation is increasing. Liver-associated mortality of HIV-coinfected subjects with viral hepatitis has become a leading cause of death in many countries [5, 6]. Despite recent advances in the treatment of chronic hepatitis B and hepatitis C, OLT remains the last
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