Perioperative considerations in HIV-infected liver transplanted patients.
The introduction of highly active antiretroviral therapy (HAART) has improved survival in HIV patients, allowing them to undergo liver transplantation (OLT) in cases of end-stage liver disease. HIV patients show a higher incidence of pulmonary hypertension. The aim of this study was to evaluate pulmonary and systemic hemodynamic changes in HIV-infected patients compared with a non-HIV-infected group of patients undergoing OLT.


METHODS
We analyzed 20 HIV-infected patients and 20 non-HIV-infected patients who underwent OLT. We analyzed preoperative cardiovascular status, as well as intra- and postoperative hemodynamic data. Hemodynamic data were recorded at 4 predefined phases during OLT and at 24, 48, and 72 hours after intensive care unit (ICU) admission. We also evaluated the following perioperative aspects: transfusion requirements, postoperative mechanical ventilation time, ventilation time, and length of ICU and of hospital stay.


RESULTS
HIV-positive patients were younger than controls with a greater incidence of coinfection with hepatotropic viruses. One HIV-infected patient died in the ICU. Hemodynamic data showed a higher cardiac index and higher pulmonary vascular resistance index among HIV-infected patients, but without any clinical impact. No significant difference in blood unit transfusions, postoperative time on mechanical ventilation, or length of ICU or hospital stay was observed between the groups.


CONCLUSIONS
Although the number of patients studied is limited, we concluded that HIV-infected patients undergoing OLT showed similar perioperative courses as non-HIV-infected patients.
Costa
M G
MG
Clinic of Anesthesia and Intensive Care Medicine, Department of Surgical Sciencé, Medical School, University of Udine, Udine, Italy. gabriella.costa@uniud.it
Pompei
L
L
Chiarandini
P
P
Lugano
M
M
Baccarani
U
U
Tavio
M
M
Della Rocca
G
G
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care