Liver transplants

In cases of severe cirrhosis or liver cancer, a liver transplant may be the only treatment option. Liver transplants for HIV-infected patients with end-stage liver disease have not been routinely performed, but some recent studies have shown that transplant outcomes in HIV-positive people with well-controlled HIV disease and CD4 cell counts above 200 cells/mm3 are almost as good as those seen in people without HIV.1,2 For example, a study with long-term follow-up data found that HIV infection did not, on average, reduce survival twelve months after transplantation.3 It can also be effective in patients with 3TC-resistant HBV.4

Following the success of transplants in this patient group, some experts have advocated for a routine approach to liver transplants in HIV-infected patients.5 In 2005, the British HIV Association (BHIVA) and the United Kingdom and Ireland Liver Transplantation Centres issued guidelines recommending that HIV-positive patients with hepatitis B or C should be considered for liver transplants if they have at least a 50% chance of surviving five years or more after receiving a new liver.

References

  1. Neff G et al. Solid organ transplantation in patients with human immunodeficiency syndrome: a successful case series. 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, abstract I-203, 2001
  2. Roland ME et al. Patient and graft outcomes following solid organ transplantation. 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, abstract 826, 2004
  3. Ragni MV et al. Survival of human immunodeficiency virus-infected liver transplant recipients. J Infect Dis 188: 1412-1420, 2003
  4. Terrault NA et al. Outcome of patients with hepatitis B virus and human immunodefiency virus infections referred for liver transplantation. Liver Transpl 12: 801-807, 2006
  5. Fishman JA Transplantation for patients infected with human immunodeficiency virus: no longer experimental but not yet routine. J Infect Dis 188: 1405-1419, 2003
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