title: Barriers to liver transplantation in HIV infected patients.
abstract: OBJECTIVE
  Liver disease is one of the most frequent causes of non AIDS related deaths in HIV patients and transplantation has become a therapeutic option. In spite of this progress, no liver transplantation has ever been recorded for the patients of the Brussels Saint-Pierre HIV Cohort. The aim of this study is to identify the barriers to liver transplantation in HIV patients that arise in our practice.
  
  
  METHODS
  All patients enrolled in the Brussels Saint-Pierre HIV Cohort presenting a theoretical indication for liver transplantation, as recommended by the AASLD, between 01/01/2002 and 01/07/2010 were considered. The reasons for not retaining these patients as candidates for liver transplantation were classified as HIV or non-HIV related.
  
  
  RESULTS
  Nineteen patients were identified. All patients presented an HBV and/or HCV co-infection. Indication for liver transplantation was based on first severe complication of cirrhosis for 15 patients, hepatocellular carcinoma fulfilling the Milan criteria for 2 and chronic liver failure for 2 others. Three patients could have been transplantation candidates but only one was enlisted and died prior to transplantation whilst alternative treatments were chosen for the remaining two. Among the non candidates, 5 couldn't be enlisted for HIV-related reasons, 3 for non HIV related reasons and 8 on multifactorial grounds; non adherence to treatment, alcohol abuse, psychiatric disease and hepatotoxicities playing key roles. Eleven patients died, all within 12 months of their first major complication of cirrhosis.
  
  
  CONCLUSIONS
  The undeniable medical progress that liver transplantation represents for HIV-infected individuals is, in practise, limited; only a minority of patients with an indication of liver transplant will fulfill the necessary criteria for enlistment. General awareness of this issue and early referral are essential to optimize pre-transplant management and increase the number of HIV patients developing ESLD that will be able to benefit from this cure.
authors.affiliation: Division of Infectious disease, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium. cwyndham@ulb.ac.be
authors.forename: C
authors.initials: C
authors.lastname: Wyndham-Thomas
authors.affiliation: Division of Infectious disease, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Delforge
authors.affiliation: Division of Infectious disease, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: J P
authors.initials: JP
authors.lastname: Mulkay
authors.affiliation: Division of Infectious disease, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: De Wit
mesh_terms: D001530:Belgium / Q000453:epidemiology; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D019694:Hepatitis B, Chronic / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000453:epidemiology; D006801:Humans; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D018579:Patient Selection; D012307:Risk Factors