INTRODUCTION: Highly active antiretroviral therapy (HAART) has been able to improve the immune system function and survival of HIV patients with a consequent increase in the number of HIV patients affected by end-stage liver disease (ESLD). Between June 2003 and October 2006, 10 HIV-positive patients underwent liver transplantations in our center. METHODS: All patients were treated with HAART before transplantation; treatment was interrupted on transplantation day and was restarted once the patients' conditions stabilized. Five patients were hepatitis C virus (HCV)-positive, 3 were hepatitis B virus (HBV)-positive, and 2 were HBV-HCV coinfected. HIV viral load before transplantation was <50 copies/mL in all cases. CD4+ cell count before transplantation ranged between 144 and 530 c/microL. Immunosuppression was based on Cyclosporine (CyA) and steroid weaning for 8 patients, and on Tacrolimus and steroid weaning for 2 patients. RESULTS: Five patients were cytomegalovirus (CMV)-positive pp65 antigenemia posttransplantation, and 1 patient was EBV-positive; 2 patients had a coinfection with HHV6. Four patients suffered from a cholestatic HCV recurrent hepatitis treated with antiviral therapy (peginterferon and Ribavirin). Three patients died after transplantation. DISCUSSION: The outcome of liver transplantation in HIV patients was influenced by infections (HCV, CMV, and EBV) and Kaposi's Sarcoma. HCV recurrence was more aggressive, showing a faster progression in this patient population. Drug interaction between HAART and immunosuppressants occurs; longer follow-up and better experience may improve the management of these drug interactions.

Human Immunodeficiency Virus and Liver Transplantation: Our Point of View / Di Benedetto, F.; Di Sandro, S.; De Ruvo, N.; Berretta, M.; Montalti, R.; Guerrini, G. P.; BALLARIN, Roberto; De Blasiis, M. G.; Spaggiari, M.; SMERIERI, Nazareno; Iemmolo, R. M.; Guaraldi, G.; Gerunda, G. E.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 40:6(2008), pp. 1965-1971. [10.1016/j.transproceed.2008.05.067]

Human Immunodeficiency Virus and Liver Transplantation: Our Point of View

F. Di Benedetto;S. Di Sandro;G. P. Guerrini;Roberto Ballarin;M. G. De Blasiis;M. Spaggiari;Nazareno Smerieri;G. Guaraldi;G. E. Gerunda
2008

Abstract

INTRODUCTION: Highly active antiretroviral therapy (HAART) has been able to improve the immune system function and survival of HIV patients with a consequent increase in the number of HIV patients affected by end-stage liver disease (ESLD). Between June 2003 and October 2006, 10 HIV-positive patients underwent liver transplantations in our center. METHODS: All patients were treated with HAART before transplantation; treatment was interrupted on transplantation day and was restarted once the patients' conditions stabilized. Five patients were hepatitis C virus (HCV)-positive, 3 were hepatitis B virus (HBV)-positive, and 2 were HBV-HCV coinfected. HIV viral load before transplantation was <50 copies/mL in all cases. CD4+ cell count before transplantation ranged between 144 and 530 c/microL. Immunosuppression was based on Cyclosporine (CyA) and steroid weaning for 8 patients, and on Tacrolimus and steroid weaning for 2 patients. RESULTS: Five patients were cytomegalovirus (CMV)-positive pp65 antigenemia posttransplantation, and 1 patient was EBV-positive; 2 patients had a coinfection with HHV6. Four patients suffered from a cholestatic HCV recurrent hepatitis treated with antiviral therapy (peginterferon and Ribavirin). Three patients died after transplantation. DISCUSSION: The outcome of liver transplantation in HIV patients was influenced by infections (HCV, CMV, and EBV) and Kaposi's Sarcoma. HCV recurrence was more aggressive, showing a faster progression in this patient population. Drug interaction between HAART and immunosuppressants occurs; longer follow-up and better experience may improve the management of these drug interactions.
40
6
1965
1971
Human Immunodeficiency Virus and Liver Transplantation: Our Point of View / Di Benedetto, F.; Di Sandro, S.; De Ruvo, N.; Berretta, M.; Montalti, R.; Guerrini, G. P.; BALLARIN, Roberto; De Blasiis, M. G.; Spaggiari, M.; SMERIERI, Nazareno; Iemmolo, R. M.; Guaraldi, G.; Gerunda, G. E.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 40:6(2008), pp. 1965-1971. [10.1016/j.transproceed.2008.05.067]
Di Benedetto, F.; Di Sandro, S.; De Ruvo, N.; Berretta, M.; Montalti, R.; Guerrini, G. P.; BALLARIN, Roberto; De Blasiis, M. G.; Spaggiari, M.; SMERIERI, Nazareno; Iemmolo, R. M.; Guaraldi, G.; Gerunda, G. E.
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