Pros and cons of liver transplantation in human immunodeficiency virus infected recipients.
Before the introduction of combined highly active antiretroviral therapy, a positive human immunodeficiency virus (HIV) serological status represented an absolute contraindication for solid organ transplant (SOT). The advent of highly effective combined antiretroviral therapy in 1996 largely contributed to the increased demand for SOT in HIV-positive individuals due to increased patients' life expectancy associated with the increasing prevalence of end-stage liver disease (ESLD). Nowadays, liver failure represents a frequent cause of mortality in the HIV-infected population mainly due to coinfection with hepatitis viruses sharing the same way of transmission. Thus, liver transplantation (LT) represents a reasonable approach in HIV patients with stable infection and ESLD. Available data presently supports with good evidence the practice of LT in the HIV-positive population. Thus, the issue is no longer "whether it is correct to transplant HIV-infected patients", but "who are the patients who can be safely transplanted" and "when is the best time to perform LT". Indeed, the benefits of LT in HIV-infected patients, especially in terms of mid- and long-term patient and graft survivals, are strictly related to the patients' selection and to the correct timing for transplantation, especially when hepatitis C virus coinfection is present. Aim of this article is to review the pros and cons of LT in the cohort of HIV infected recipients.
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy.
Umberto
U
Baccarani
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy.
Elda
E
Righi
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy.
Gian Luigi
GL
Adani
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy.
Dario
D
Lorenzin
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy.
Alberto
A
Pasqualucci
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy.
Matteo
M
Bassetti
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy.
Andrea
A
Risaliti
D023241:Antiretroviral Therapy, Highly Active; D060085:Coinfection; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000401:mortality / Q000601:surgery* / Q000821:virology; D006085:Graft Survival; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000401:mortality / Q000821:virology; D020276:HIV Long-Term Survivors; D006526:Hepatitis C / Q000276:immunology / Q000821:virology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014181:Transplantation Immunology; D016896:Treatment Outcome
Hepatocellular carcinoma; Human immunodeficiency virus/hepatitis C virus coinfection; Immunosuppression; Liver transplantation