Orthotopic liver transplantation in human immunodeficiency virus (HIV)-positive patients: outcome of 7 patients from the Bonn cohort.
The outcome and clinical features of 7 HIV-positive patients who were liver transplanted at Bonn University in the era of highly active antiretroviral therapy (HAART) between 1997 and 2004, analyzed by retrospective chart review, are reported. Reasons for orthotopic liver transplantation (OLT) were end-stage liver disease due to chronic hepatitis C (n = 4) or hepatitis B (n = 1) or acute liver failure due to fulminant hepatitis B (n = 2). Immunosuppression was based on cyclosporine A and prednisone. HAART was reinitiated 1 month after transplantation, and immunosuppression was carefully adapted to account for drug-drug interactions between cyclosporine A and protease inihibitors. Prednisone was withdrawn 5 months (median) after OLT when immunosuppression had been reliably established in the presence of HAART. One patient died 95 days after OLT due intrathoracic hemorrhage, whereas 6 patients were alive at a median of 24 months. A single episode of acute rejection was observed. The spectrum of postoperative complications was no different from HIV-negative patients apart from Kaposi's sarcoma and multicentric Castleman's disease in a single patient. Recurrent hepatitis B infection was efficiently prevented, whereas hepatitis C reinfection occurred in all 4 patients who had preexisting hepatitis C. Earlier reports on fatal courses of recurrent hepatitis C infection, high rates of organ rejection, and HAART-related liver toxicity were not observed in our patients. In conclusion, even though preliminary, our data suggest that outcomes after liver transplantation of HIV-infected patients can be improved.
Vogel
Martin
M
Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany.
Voigt
Esther
E
Schäfer
Nico
N
Goldmann
Georg
G
Schwarz
Nicolas
N
Kalff
Jörg C
JC
Sauerbruch
Tilman
T
Wolff
Martin
M
Rockstroh
Jürgen Kurt
JK
Spengler
Ulrich
U
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D004279:DNA, Viral / Q000032:analysis; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006678:HIV / Q000235:genetics / Q000276:immunology; D015483:HIV Antibodies / Q000032:analysis; D006679:HIV Seropositivity; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D004279:DNA, Viral; D015483:HIV Antibodies