The First Case of Deceased Donor Liver Transplantation for a Patient with End-Stage Liver Cirrhosis Due to Human Immunodeficiency Virus and Hepatitis C Virus Coinfection in Japan

Abstract

SUMMARY:We previously reported that progression of liver cirrhosis is quicker and survival is dismal in patients with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection, especially when acquired in childhood through contaminated blood products. Recently, we performed the first deceased donor liver transplantation (DDLT) for an HIV/HCV-coinfected hemophilic patient in Japan. A 40-year-old man was referred to our hospital for liver transplantation. Regular DDLT was performed using the piggyback technique with a full-sized liver graft. Cold ischemia time was 465 min, and the graft liver weighed 1,590 g. The antiretroviral therapy (ART) was switched from darunavir/ ritonavir to raltegravir before the transplant for flexible usage of calcineurin inhibitors postoperatively; tenofovir was used as the baseline treatment. The postoperative course was uneventful, and the patient was discharged home on day 43. He started receiving anti-HCV treatment on day 110 with pegylated interferon, ribavirin, and simeprevir after the DDLT. Herein, we report the first case of DDLT in Japan. Meticulous management of ART and clotting factors could lead to the success of DDLT.

Impact of sustained viral response for hepatitis C virus on the outcomes of liver transplantation in hemophilic patients with human immunodeficiency virus/hepatitis C virus co‐infection: A nationwide survey in Japan

“…HCV reinfection in the graft liver showed unusual progression, probably due to the presence of HIV with immunosuppression and the hepatotoxicity of previous anti-HIV drugs. [22][23][24] However, because of the advent of DAA, HCV infection could be well controlled without the adverse effects previously seen after interferon/ribavirin therapy. 25 Recently, it has been reported that DAA treatment is very effective for patients co-infected with HCV/HCV before and after LT in Germany.…”

“…In the earlier era without DAA treatment, the results of LT were rather dismal even with interferon/ribavirin therapy, with recurrent HCV‐related liver cirrhosis. HCV reinfection in the graft liver showed unusual progression, probably due to the presence of HIV with immunosuppression and the hepatotoxicity of previous anti‐HIV drugs 22–24 . However, because of the advent of DAA, HCV infection could be well controlled without the adverse effects previously seen after interferon/ribavirin therapy 25 .…”

The treatment choices and outcome of hepatocellular carcinoma in hemophilic patients with human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfection due to contaminated blood products in Japan

“…As a result, outcomes for HCC in this population have been reported to be generally poor (5,6). Although surgery, including liver transplantation (LT) (7,8), has been reported as feasible in hemophilic patients, physicians might hesitate to refer such patients not only to surgery, but also to less invasive procedures such as radio frequency ablation (RFA).…”