Journal
WORLD JOURNAL OF GASTROENTEROLOGY
Volume 29, Issue 11, Pages 1745-1756Publisher
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v29.i11.1745
Keywords
ABO incompatibility liver transplantation; Human immunodeficiency virus; Hepatitis B virus; End-stage liver disease; Immunosuppression
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This study examines the outcome of ABO-incompatible liver transplantation (ABOi-LT) in HIV-HBV coinfected patients. The results show that ABOi-LT is feasible and safe for HIV-HBV coinfected patients with end-stage liver disease (ESLD), with positive intermediate-term outcomes such as decreased HIV viral load and stable liver function.
BACKGROUND Human immunodeficiency virus (HIV)-positive patients coinfected with hepatitis B virus (HBV) are eligible for liver transplantation (LT) in Africa and Southeast Asia, particularly China. However, the outcome of HIV-HBV coinfected patients referred for ABO-incompatible LT (ABOi-LT) is unknown. AIM To clarify the outcome of ABOi-LT for HIV-HBV coinfected patients with end-stage liver disease (ESLD). METHODS We report on two Chinese HIV- HBV coinfected patients with ESLD who underwent A to O brain-dead donor LT and reviewed the literature on HIV-HBV coinfected patients treated with ABO-compatible LT. The pretransplantation HIV viral load was undetectable, with no active opportunistic infections. Induction therapy consisted of two sessions of plasmapheresis and a single dose of rituximab in two split doses, followed by an intraoperative regimen of intravenous immunoglobulin, methylprednisolone, and basiliximab. Post-transplant maintenance immunosuppressive agents consisted of tacrolimus and mycophenolate mofetil, and prednisone. RESULTS At the intermediate-term follow-up, patients showed undetectable HIV viral load, CD4(+) T cell counts greater than 150 cells/mu L, no HBV recurrence, and stable liver function. A liver allograft biopsy showed no evidence of acute cellular rejection. Both patients survived at 36-42 mo of follow-up. CONCLUSION This is the first report of ABOi-LT in HIV- HBV recipients with good intermediate-term outcomes, suggesting that ABOi-LT may be feasible and safe for HIV-HBV coinfected patients with ESLD.
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