Perspectives on Liver and Kidney Transplantation in the Human Immunodeficiency Virus-Infected Patient

Abstract

HIV-infection is no longer an absolute contraindication for transplantation for patients with advanced kidney and liver failure. This article reviews the outcome data in the solid organ transplantation of HIV-infected patients that led to a change in thinking by the transplant community. We then review several emerging issues in the field such as eligibility criteria, selection of optimal immunosuppression agents and antiretroviral therapy in this population, and management of co-infection with Hepatitis B and Hepatitis C post-transplant.

HIV and Liver transplantation: The British Columbia Experience, 2004 to 2013

“…Concerns surrounding opportunistic infections due to immunocompromise and reduced survival have been attenuated (1). …”

“…Despite these additional complexities, multiple studies have demonstrated that graft and patient survivorship are comparable between HIV-infected and noninfected groups (3). HIV infection is, thus, no longer considered to be a contraindication to liver transplantation (1). …”

Double lung transplantation in an HIV‐positive patient with Mycobacterium kansasii infection

“…Multiple evidence shows that immunosuppression in the context of SOT does not cause neither progression of HIV disease nor loss of viral suppression in patients taking ART . Our patient maintained an excellent immunovirologic control during the 15 months following transplantation.…”

“…A major concern about SOT in the HIV‐infected population is drug‐drug interactions. Antiretrovirals, especially protease inhibitors, are powerful cytochrome inhibitors that affect the metabolism of immunosuppressive drugs such as tacrolimus or cyclosporine making their adjustment quite challenging . Hence, inadequate exposure to immunosuppressive drugs with subtherapeutic serum levels may lead to graft rejection in the patient .…”

Cirrhosis and liver transplantation in patients co-infected with HIV and hepatitis B or C: an observational cohort study

“…This was principally due to poor patient and graft survival as the immunosuppression required to prevent organ rejection frequently resulted in infectious complications as well as aggressive HCV recurrence [ 5 ]. Now, as well as improved survival in HIV-positive persons due to cART, recent advances in the treatment of hepatitis C with directly acting antiviral agents (DAAs) and prophylaxis of opportunistic infections mean that liver transplantation may be an increasingly viable option for co-infected patients with end-stage liver disease [ 6 ].…”