Liver transplantation in HIV-positive patients.
OBJECTIVE
The aim of this study was to evaluate the feasibility of liver transplantation (OLT) in human immunodeficiency virus (HIV), hepatitis C virus (HCV) coinfected patients in Italy.


METHODS
Between September 2002 and April 2006, 12 HIV(+) coinfected patients (11 men, mean age 42 years) underwent OLT at our Institute. Eleven (91%) patients were HCV-positive and one was hepatitis B virus-positive. Pre-OLT plasma HIV 1-RNA level was undetectable and CD4(+) T-cell count >200 cells/microL for 3 months in all patients. Six patients had to stop highly active antiretroviral therapy (HAART) before OLT because of liver disease severity (n = 2) and for hepato cellular carcinoma (n = 4).


RESULTS
The actuarial 1-, 2-, and 3-year survival rates were 83.3%, 58.3%, and 58.3%, respectively, which were significantly lower than those observed among HIV-negative patients transplanted in our center. Six patients are alive with a mean follow-up of 26 months (range: 5 to 46 months). We recorded a low rate of opportunistic infections and rejection. All alive patients have low levels of HIV RNA, and the CD4(+) T-cell counts increased after OLT. Nine patients developed early recurrence of hepatitis C requiring combination therapy with peg-interferon plus ribavirin. Significant improvement in the quality of life was observed in 7/11 patients.


CONCLUSIONS
OLT in HIV-positive patients was feasible with good results in the short and medium term. Early severe HCV recurrence may be observed. Key challenges for the management of HIV(+) patients after transplantation included treatment of severe HCV recurrence and attention to the pharmacological interactions of HAART with immunosuppressive drugs.
Vennarecci
G
G
Department of Surgical Oncology and Liver Transplantation, Regina Elena Cancer Institute, Rome, Italy. vennarecci@ifo.it
Ettorre
G M
GM
Antonini
M
M
Santoro
R
R
Perracchio
L
L
Visco
G
G
Santoro
E
E
D000328:Adult; D006084:Graft Rejection / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D018023:HIV Seronegativity; D015497:HIV-1; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000150:complications / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D018579:Patient Selection; D012367:RNA, Viral / Q000302:isolation & purification; D012189:Retrospective Studies; D016019:Survival Analysis
D012367:RNA, Viral