title: En Bloc Multivisceral and Kidney Transplantation in an HIV Patient: First Case Report.
abstract: The continual improvement in outcome with highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection and visceral transplantation for gut failure stimulated our interest in lifting HIV infection as a contraindication for intestinal and multivisceral transplantation. This report is the first to describe visceral transplantation in a patient with HIV infection. A HAART regimen was introduced in the setting of short-gut syndrome with successful suppression of HIV viral load. The indication for en bloc multivisceral and kidney transplantation was end-stage liver failure with portomesenteric venous thrombosis and chronic renal insufficiency. The underlying hepatic pathology was alcoholic and home parenteral nutrition-associated cirrhosis. Surgery was complicated due to technical difficulties with excessive blood loss and long operative time. The complex posttransplant course included multiple exploratory laparotomies due to serious intra-abdominal and systemic infections. Heavy immunosuppression was required to treat recurrent episodes of severe allograft rejection. Posttransplant oral HAART successfully sustained undetectable viral load. Unfortunately, the patient succumbed to sepsis 3 months posttransplant. With new insights into the biology of gut immunity, mechanisms of allograft tolerance, and HIV-associated immune dysregulation, successful outcome is anticipated, particularly in patients who are in need of isolated intestinal and less-organ-contained visceral allografts.
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
authors.forename: C E
authors.initials: CE
authors.lastname: Koval
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, OH.|Transplantation Center, Cleveland Clinic, Cleveland, OH.
authors.forename: A
authors.initials: A
authors.lastname: Khanna
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
authors.forename: A
authors.initials: A
authors.lastname: Pallotta
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
authors.forename: M
authors.initials: M
authors.lastname: Spinner
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
authors.forename: A J
authors.initials: AJ
authors.lastname: Taege
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: B
authors.initials: B
authors.lastname: Eghtesad
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, OH.|Transplantation Center, Cleveland Clinic, Cleveland, OH.
authors.forename: M
authors.initials: M
authors.lastname: Fujiki
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, OH.|Transplantation Center, Cleveland Clinic, Cleveland, OH.
authors.forename: K
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Division of Infectious Disease, Case Western Reserve University, Cleveland, OH.
authors.forename: B
authors.initials: B
authors.lastname: Rodriguez
authors.affiliation: Department of Pharmacy, University of Buffalo, Buffalo, NY.
authors.forename: G
authors.initials: G
authors.lastname: Morse
authors.affiliation: Department of Pathology, Cleveland Clinic, Cleveland, OH.
authors.forename: A
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, OH.|Transplantation Center, Cleveland Clinic, Cleveland, OH.
authors.forename: K
authors.initials: K
authors.lastname: Abu-Elmagd
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D006085:Graft Survival; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D017093:Liver Failure / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011183:Postoperative Complications; D011379:Prognosis; D014781:Viscera / Q000637:transplantation*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: clinical research / practice; infection and infectious agents; infectious disease; intestinal failure / injury; intestine / multivisceral transplantation; viral: human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS)