title: HIV and liver transplantation: The British Columbia experience, 2004 to 2013.
abstract: BACKGROUND
  The demand for definitive management of end-stage organ disease in HIV-infected Canadians is growing. Until recently, despite international evidence of good clinical outcomes, HIV-infected Canadians with end-stage liver disease were ineligible for transplantation, except in British Columbia (BC), where the liver transplant program of BC Transplant has accepted these patients for referral, assessment, listing and provision of liver allograft. There is a need to evaluate the experience in BC to determine the issues surrounding liver transplantation in HIV-infected patients.
  
  
  METHODS
  The present study was a chart review of 28 HIV-infected patients who were referred to BC Transplant for liver transplantation between 2004 and 2013. Data regarding HIV and liver disease status, initial transplant assessment and clinical outcomes were collected.
  
  
  RESULTS
  Most patients were BC residents and were assessed by the multidisciplinary team at the BC clinic. The majority had undetectable HIV viral loads, were receiving antiretroviral treatments and were infected with hepatitis C virus (n=16). The most common comorbidities were anxiety and mood disorders (n=4), and hemophilia (n=4). Of the patients eligible for transplantation, four were transplanted for autoimmune hepatitis (5.67 years post-transplant), nonalcoholic steatohepatitis (2.33 years), hepatitis C virus (2.25 years) and hepatitis B-delta virus coinfection (recent transplant). One patient died from acute renal failure while waiting for transplantation. Ten patients died during preassessment and 10 were unsuitable transplant candidates. The most common reason for unsuitability was stable disease not requiring transplantation (n=4).
  
  
  CONCLUSIONS
  To date, interdisciplinary care and careful selection of patients have resulted in successful outcomes including the longest living HIV-infected post-liver transplant recipient in Canada.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario;
authors.forename: Clara
authors.initials: C
authors.lastname: Tan-Tam
authors.affiliation: Obstetrics and Gynecology, University of Toronto, Toronto, Ontario;
authors.forename: Pamela
authors.initials: P
authors.lastname: Liao
authors.affiliation: Division of AIDS, University of British Columbia; ; Division of Gastroenterology, University of British Columbia;
authors.forename: Julio S
authors.initials: JS
authors.lastname: Montaner
authors.affiliation: Division of AIDS, University of British Columbia; ; Division of Gastroenterology, University of British Columbia;
authors.forename: Mark W
authors.initials: MW
authors.lastname: Hull
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario; ; BC Centre for Excellence in HIV/AIDS, Vancouver General Hospital, Vancouver, British Columbia.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Scudamore
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver General Hospital, Vancouver, British Columbia ; Liver Transplant Program, Vancouver General Hospital, Vancouver, British Columbia.
authors.forename: Siegfried R
authors.initials: SR
authors.lastname: Erb
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver General Hospital, Vancouver, British Columbia ; Liver Transplant Program, Vancouver General Hospital, Vancouver, British Columbia.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
keywords: HIV; Hepatitis; Liver; Transplant