Outcome after Orthotopic Liver Transplantation in 33 Human Immunodeficiency Virus (HIV)-Positive Patients in Germany: Recurrence of Chronic Hepatitis-C Infection after Transplantation

Abstract

Background: The introduction of HAART has led to a dramatic reduction in HIV-associated morbidity and mortality. As a consequence liver disease associated complications have become an increasing clinical challenge. With one third of European HIV-patients having hepatitis C co-infection and 6-9 % hepatits B co-infection a rising need for liver organ transplantation (OLTX) has emerged. The current study evaluates the outcome of OLTX in HIV-patients in Germany. Methods: Retrospective chart analysis of 33 HIV-positive patients who were liver transplanted in 9 German transplant centers (Bonn n=11, Essen n=8, Heidelberg n=4, Hamburg n=3, Frankfurt n=2, Mainz n=1, Tübingen n=1, Regensburg n=2, Hannover n=1) between 1997-2010. Results: Reasons for OLTX were end-stage liver disease (ESLD) due to hepatitis C (n =15, with 4 having additionally HCC) ESLD due to HBV (n =9, one with additional alcoholic cirrhosis and one with HCC), one with Budd-Chiari syndrome (n=1) and HBV/HCV/HDV-coinfection (n=1). The median CD4 T-cell count before transplantation was 223/μl (IQR,158-372). Of all transplanted patients 17/26 are still alive in 2010 with a median survival of 30 months (IQR,1-153). 9/33 patients died, 5 in the early post-transplantation period within 3 months, one due to organ rejection and acute renal failure, the other because of intrathoracal hemorrhage and 3 of septicemia. 4 patients died after 8, 10, 31 and 56 months respectively, 1 due to anastamotic leak with massive bleeding, 2 because of secondary graft failure and 1 after re-re-transplantation of septicaemia. Recurrent hepatitis B infection was efficiently prevented in 8/9 patients, whereas hepatitis C reinfection occurred in all patients. Conclusion: OLTX is a feasible approach in HIV-infected patients with ESLD in Germany with overall acceptable survival rates. Reinfection with HCV remains one of the biggest clinical challenges after OLTX in HIV/HCV coinfection.