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Abstract: I-203. Solid Organ Transplantation in Patients with Human
Immunodeficiency Syndrome: a Successful Case Series.
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G.T. NEFF, D. JAYAWEERA, O. HUNG, D. LEVI, D. WEPPLER, J. NERRY, T. KATO, L.
DOWDY, C. OBRIAN, K. REDDY, L. KRAVETZ, E. SCHIFF, A. TZAKIS
University of Miami, Miami, FL
Introduction: We report the results of a series of patients with human
immunodeficiency syndrome (HIV) co-infected with Hepatitis B (HBV) and/or C
(HCV) and decompensated cirrhosis receiving orthotopic liver transplantation
(OLT).
Methods: Six patients with HIV with decompensated cirrhosis secondary to HBV
and/or HBV were listed for OLT based on UNOS criteria. All patients were
reviewed and treated by the University of Miami HIV team. Highly active
antiretroviral therapy (HAART) regimen was initiated prior to OLT in 5/6
patients. One patient presented with fulminant hepatitis and we were unable
to initiate the HAART regimen prior to OLT. Patients are followed by a team
of transplant surgeons/hepatology/HIV team.
Results: The patients demographics include: 5 men and 1 women, mean age 49
years (43-52Y), 4/6 with HBV, 3/6 patients with HCV (the poster reported 1/6
had HCV but I spoke with Neff and he said that was a misprint as 3 patients
had HCV; after we spoke, he changed the poster by pen), 1/6 patients with
both HCV and HBV. All but one had an HIV viral load (HIV-VL) < 50 copies/cc3
RNA PCR, and CD4 count >100 cells/mm3 prior to OLT. Five patients
successfully received OLT. One patient succumbed to sepsis while awaiting
OLT. The 5 patients that received OLT have to date survival period of 5, 6,
7, 12, 24 months (mean 10.8). One patient suffered acute rejection and
another wound infection but both recovered. Two patients experienced
tacrolimus toxicity due to drug interaction with the protease inhibitors. All
patients are on a HAART therapy and remained with a CD 4 count >100
cells/mm3. All but one had the HIV-VL undetectable. Patient with HIV rebound
is now responding to treatment. None on the 5 patients have experienced an
opportunistic infection post OLT. Neff told me 2/3 with HCV were doing well
about 1.5 years after transplant but the other patient was not doing well.
Conclusion: Although, these results are preliminary, they suggest that
patients infected with HIV suffering from decompensated cirrhosis associated
with HBV and/or HCV co-infection, may be suitable candidates for OLT.
Note from Jules Levin: Neff told me he has a number of patients on their
waiting list. A number of small preliminary studies show that HCV/HIV
coinfected patients appear to be good transplant candidates and respond as
well as non-HIV infected patients with HCV. Reimbursers are generally not
reimbursing for liver transplants in HCv/HIV coinfected patients as they
consider the treatment too experimental.
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