Background: Liver transplantation (LT) for patients with Human immunodeficiency virus type-1 (HIV-1) infection has been associated with poor outcome. However, after the introduction of the highly active antiretroviral therapy (HAART), short- term patient survival after LT has improved significantly. Many HIV-1 infected patients are co-infected with hepatitis C virus (HCV) and/or hepatitis B virus (HBV). Hence, liver disease has become a significant cause of mortality in HIV infected patients.
Methods: We examined the long-term outcome of HIV-1 positive patients who underwent LT. Medical records were analyzed in 9 HIV-1 positive LT patients (8 male, 1 female, age range 37 -60 years) who underwent LT from August 1998 to May 2012 at our institute. Eight were known to be HIV-1 positive at the time of listing for LT and had end-stage liver disease (ESLD) due to hepatitis C (one also had HBV co-infection). Out of the first five patients, four had HCV and HIV-1 infection second to previous treatment for hemophilia A, and one due to primary biliary cirrhosis (PBC) without i.v. drug use (IVDU), the following four patients had acquired their infection due to IVDU. One patient had PBC and primary HIV-1 infection was found at the date of LT.
Results: Seven patients out of 9 remain alive to date. One patient died 3 months after LT with a functioning graft. Another patient underwent retransplantation 6 months after the first LT due to cholestatic liver failure and died 8 months after re-LT due to the same problem. So far, three patients have survived more than 10 years after LT. Five and 10 year overall patient survival rate is 74.1% and 74.1%. Four patients experienced acute rejection. Eight patients showed increased postoperative HCV RNA level and five patients acquired biopsy-confirmed clinical HCV recurrence. HIV-1 replication was effectively blocked during follow-up in all patients.
Conclusion: We conclude that long-term survival of HIV-1 positive patients after LT can be achieved. Our study suggests that LT can offer an effective treatment option in selected HIV-1 infected patients with ESLD.
To cite this abstract in AMA style:Yamamoto S, Schwarcz R, Weiland O, Oksanen A, Wernersson A, Söderdahl G, Sönnerborg A, Ericzon B. Long-Term Outcomes of Liver Transplant Patients with HIV-1 Infection: a 14-Year Single-Center Clinical Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/long-term-outcomes-of-liver-transplant-patients-with-hiv-1-infection-a-14-year-single-center-clinical-experience/. Accessed January 17, 2018.
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