|
9th Annual Conference Of The British HIV Association [BHIVA]24 – 26 April 2003, University of Manchester
|
[AUTHOR(S):] S Norris, C Taylor, C McDonald, J O'Grady, BC Portmann, AS Knisely, M Bowles, P Muiesan, M Rela and N Heaton
King's College Hospital, London, UK
BHIVA Conf 2003 Apr 24-26;9:O18
INTRODUCTION: Liver transplantation (LT) in HIV-positive individuals is still considered to be an experimental therapy with limited worldwide experience, and few long-term survival data. Published data suggest that the short-term outcome after LT is encouraging in selected patients. In the current study, we report our experience in 12 HIV-positive liver allograft recipients, and compare the outcomes of those co-infected with hepatitis C virus (HCV) to the non-HCV group.
METHODS: 12 HIV-infected patients (10 male, two female, age range 26-59 years) underwent LT between January 1995 and March 2002. Indications for LT were HCV (n=5), hepatitis B virus (HBV) (n=4), ALD (n=2), and non-A, non-B hepatitis (n=1); three patients presented with acute liver failure. At LT, CD4 counts were 124–500 cells/µl (mean 267), and HIV viral loads from <50 to 197,000 copies/ml. Seven of 12 patients were exposed to highly active antiretroviral therapy (HAART) prior to LT.
RESULTS: In the non-HCV group (n=7), all patients are alive, with five surviving more than 365 days (range 4–67 months). No patient experienced HBV recurrence, and graft function is normal in all seven recipients. In contrast, all HCV-infected patients died after LT at 95– 784 days (median 161). Four patients died of complications due to recurrent HCV infection and sepsis, despite antiviral therapy in three. Three patients experienced complications relating to HAART therapy.
CONCLUSIONS: The long-term outcome of LT in HIV-infected patients with HBV or other causes of chronic liver disease indicates that this is an acceptable therapeutic option for these patients. However, the long-term prognosis for HCV-HIV co-infected patients must remain guarded.
PRESENTING AUTHOR: C McDonald
030424
O18
Copyright © 2003 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD