Orthotopic Liver Transplantation in Human Immunodeficiency Virus (HIV)-Positive Patients in Germany

Introduction: The introduction of HAART has led to a dramatic reduction in HIV-associated morbidity and mortality. As a consequence liver-disease associated complications have become an increasing clinical challenge. The summary evaluates the outcome of orthotopic liver transplanted (OLT) HIV-patients in Germany. Methods: Retrospective chart analysis of 32 HIV-positive patients who were liver transplanted in 9 German transplant centers between 1997–2010. Results: Reasons for OLT were end-stage liver disease (ESLD) due to hepatitis C (n=19, with 5 additionally having hepatocellular carcinoma (HCC), ESLD due to HCV/HBV-coinfection (n=1, additionally having HCC), ESLD due to HBV (n=10, one with additional alcoholic cirrhosis and one with HCC), Budd-Chiari syndrome (n=1) and ESLD due to HBV/HCV/HDV-coinfection (n=1). The median CD4 T-cell count before transplantation was 256/ µl (IQR,192–368). Of all transplanted patients 22/32 are still alive in 2010 with a median survival of 57 months (IQR,38–75). 10/32 (31%) patients died, 5 in the early post-transplantation period (first 3 months), due to primary graft dysfunction (n=1), intrathoracal hemorrhage (n=1) and septicaemia (n=3). 5 patients died after 7, 8, 10, 31 and 56 months, respectively, as a consequence of skeletal metastasis of an HCC (n=1), an multiorgan failure and septicaemia (n=1), graft failure (n=2) and septicaemia after re-re- transplantation (n=1). Recurrent hepatitis B infection was efficiently prevented in 11/12 patients by antiretroviral prophylaxis, whereas hepatitis C reinfection occurred in all patients and contributed to mortality. Interferon based antiviral therapy of HCV re-infection achieved sustained virological response in 5 of the interferon treated 7 patients. Conclusions: Overall OLT is a feasible approach in HIV-infected patients with acceptable survival rates in Germany. Reinfection with HCV still remains a major clinical challenge in HIV/HCV coinfection after OLT.

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HCV - HIV - liver transplantation