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 24 November 2017

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News

Liver transplantation should not be ruled out in HIV-positive patients

The early outcome of liver transplantation in HIV-positive patients can be good, and patients should not be excluded from transplantation if their liver disease determines their prognosis, claims a team from London, England.

News image

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The researchers evaluated liver transplantation in adults coinfected with HIV, and reported their findings in the latest issue of Transplantation.

Liver transplantation in HIV-positive patients remains controversial. The finding of HIV is usually considered a contraindication to any form of transplantation.

Previously reported cases are few, and refer to patients who tested HIV-positive after they had their liver transplantations or who seroconverted in the post-transplantation period.

This is, to the author's knowledge, the only report of patients who were known to be HIV-positive at the time of decision for listing for transplantation.

The medical records of 5 HIV-positive patients who received liver transplants in King's College Hospital, London, during a 5-year period (January 1995-December 1999) were reviewed.

All 5 were known to be HIV-positive at the time of listing for liver replacement.

Three of them had end-stage liver disease due to hepatitis C (2 had underlying Hemophilia A). The other 2 had acute liver failure, 1 due to hepatitis B infection and 1 due to non-A, non-B, non-C hepatitis.

In all but one of the patients the HIV infection had been asymptomatic.

More effective antiviral therapy should improve transplant outcome in HIV infected adults.
Transplantation
All patients survived the immediate post-transplantation period.

However, the 3 patients with hepatitis C died of complications of recurrent hepatitis C, between 6 and 25 months post-transplantation.

The other 2 patients are currently alive 4 and 34 months post-transplantation with good graft function, and without complications from their HIV infection.

Andreas A. Prachalias, of the Institute of Liver Studies, King's College Hospital, said on behalf of fellow colleagues, "The early outcome of liver transplantation in HIV seropositive patients can be good, and patients should not be excluded from transplantation if their liver disease determines their prognosis."

"More effective antiviral therapy for hepatitis C given post-transplantation, and for hepatitis B reinfection, should improve the longer-term outcome of HIV patients with end-stage liver disease due to hepatitis," it was concluded.

In an accompanying Analysis and Commentary, Tim Wreghitt, of Addenbrooke's Hospital, Cambridge, England, comments on the paper:

"With the availability of highly active antiretroviral therapy, and with careful selection of patients based on recognized criteria, some HIV-antibody-positive patients should have a similar clinical outcome post-transplantation to HIV-antibody-negative recipients."

Transplantation 2001; 72(10): 1684-8
06 December 2001

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