Liver transplant in patients with viral hepatitis and human immunodeficiency virus coinfection the first 2 cases in Turkey

Abstract

Objectives: The outcomes of liver transplant in human immunodeficiency virus-infected patients are improving with advances in antiretroviral treatment. Data about such cases are rare in Turkey. We present the first 2 living-donor liver transplants performed in Turkey in patients with viral hepatitis/human immunodeficiency virus coinfection. Case 1: A 47-year-old man infected with human immunodeficiency virus with chronic hepatitis B and D and hepatocellular carcinoma within the Milan criteria had been taking antiretroviral medication before his liver transplant. An unrelated right lobe liver transplant was performed uneventfully in this patient, who was human immunodeficiency virus RNA-negative and had a CD4 T-cell count of 500/μL. Antiretroviral treatment continued in the early postoperative period, and a triple immuno-suppressive regimen consisting of cyclosporine, mycophenolate mofetil, and steroids was initiated. Burkholderia cepacia pneumonia developed post­operatively, and was treated successfully. The patient was discharged on postoperative day 18, and is still alive 58 months after the operation. Case 2: A 62-year-old man with human immuno-deficiency virus and chronic hepatitis C virus infection was taking antiretroviral treatment before the liver transplant. The patient was hepatitis C virus RNA-positive, human immunodeficiency virus RNA-negative, and had a CD4 T-cell count of 620/μL. His son was the donor, and a right lobe liver transplant was performed uneventfully in antiretroviral treatment continued in the early postoperative period and a triple immunosuppressive regimen consisting tacrolimus, mycophenolate mofetil, and steroids was initiated. Broad-spectrum β-lactamase-positive Escherichia coli bacteremia and hospital-acquired pneumonia developed postoperatively and were treated successfully. The patient was discharged on postoperative day 19, and remains alive 13 months after the operation. Conclusions: Living-donor liver transplant is a promising treatment choice for end-stage liver disease in human immunodeficiency virus-infected patients.