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Salas J, Storm K, Durand CM. Organ Donors with Human Immunodeficiency Virus and Hepatitis C Virus: Expanding the Donor Pool. Infect Dis Clin North Am 2023:S0891-5520(23)00039-9. [PMID: 37258326 DOI: 10.1016/j.idc.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Using organs from donors with treatable infections is a strategy to increase the quality and number of organs for transplantation. For HIV, pilot studies of kidney and liver transplantation from donors with HIV to recipients with HIV demonstrate excellent early outcomes. However, the number of donors and transplants per year remains lower than projected due to several barriers. For HCV, the use of organs from donors with HCV has expanded to recipients without HCV due to safe, effective direct-acting antivirals for HCV, which are well-tolerated in transplant recipients. Studies across organ types demonstrate good outcomes and shorter wait times.
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Affiliation(s)
- Jordan Salas
- Department of Medicine, Johns Hopkins University School of Medicine, 2000 East Monument Street, Baltimore, MD 21205, USA; Department of Medicine, Oregon Health & Science University School of Medicine, 3181 Southwest Sam Jackson Park Road, Portland, OR, USA
| | - Kaitlyn Storm
- Department of Medicine, Johns Hopkins University School of Medicine, 2000 East Monument Street, Baltimore, MD 21205, USA
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, 2000 East Monument Street, Baltimore, MD 21205, USA.
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2
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Kumar RN, Stosor V. Advances in Liver Transplantation for Persons with Human Immunodeficiency Infection. Curr Infect Dis Rep 2022; 24:39-50. [PMID: 35308580 PMCID: PMC8922075 DOI: 10.1007/s11908-022-00776-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca N. Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611 USA
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3
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Nel JS, Conradie F, Botha J, Etheredge H, Fabian J, Levin L, Mazanderani AH, Moorhouse M, Muller E, Tiemessen C, Thomson D, Turner J. Southern African HIV Clinicians Society guidelines for solid organ transplantation in human immunodeficiency virus: An evidence-based framework for human immunodeficiency virus-positive donors and recipients. South Afr J HIV Med 2020; 21:1133. [PMID: 33240537 PMCID: PMC7670031 DOI: 10.4102/sajhivmed.v21i1.1133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeremy S Nel
- Helen Joseph Hospital, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesca Conradie
- Clinical HIV Research Unit, Wits Health Consortium, Johannesburg, South Africa.,Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Helen Joseph Hospital, Johannesburg, South Africa
| | - Jean Botha
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | | | - June Fabian
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa.,Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Leon Levin
- Helen Joseph Hospital, Johannesburg, South Africa.,Right to Care, NGO, Johannesburg, South Africa
| | - Ahmad H Mazanderani
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | | | - Elmi Muller
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Caroline Tiemessen
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,DST/NRF Chair of HIV Vaccine Translational Research, Pretoria, South Africa
| | - David Thomson
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
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4
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Waldman G, Rawlings SA, Kerr J, Vodkin I, Aslam S, Logan C, Dan J, Mehta S, Hill L, Karris MY. Successful optimization of antiretroviral regimens in treatment-experienced people living with HIV undergoing liver transplantation. Transpl Infect Dis 2019; 21:e13174. [PMID: 31520554 PMCID: PMC7510623 DOI: 10.1111/tid.13174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/16/2019] [Accepted: 09/01/2019] [Indexed: 01/13/2023]
Abstract
Modern antiretroviral therapy (ART) extends life expectancy for people living with HIV (PLWH). However, most older PLWH (≥50 years) "aged" with HIV and were exposed to historical HIV care practices and older, more toxic ART. In PLWH with exposure to older and multiple ART regimens, the drug interactions between ART frequently used in treatment-experienced persons and commonly used immunosuppressants remain a significant challenge. However, the advent of newer ART classes (eg, integrase non-strand transfer inhibitors) and more advanced HIV genetic resistance testing may allow optimization of ART regimens with minimal drug interactions. Here, we present a case series of three PLWH whose complicated ART interacted (or was at risk for interacting) with their post-liver transplant immunosuppression. After a review of their proviral DNA resistance testing, they successfully transitioned onto safer integrase non-strand transfer inhibitor-containing ART regimens without viral blips or evidence of organ rejection.
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Affiliation(s)
- Georgina Waldman
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA
| | - Stephen A Rawlings
- Department of Medicine, School of Medicine, University of California, San Diego, CA
| | - Janice Kerr
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA
| | - Irine Vodkin
- Department of Medicine, School of Medicine, University of California, San Diego, CA
| | - Saima Aslam
- Department of Medicine, School of Medicine, University of California, San Diego, CA
| | - Cathy Logan
- Department of Medicine, School of Medicine, University of California, San Diego, CA
| | - Jennifer Dan
- Department of Medicine, School of Medicine, University of California, San Diego, CA
| | - Sanjay Mehta
- Department of Medicine, School of Medicine, University of California, San Diego, CA
- Department of Pathology, School of Medicine, University of California, San Diego, CA
- Department of Medicine, San Diego Veterans Affairs Medical Center, San Diego, CA
| | - Lucas Hill
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA
| | - Maile Y Karris
- Department of Medicine, School of Medicine, University of California, San Diego, CA
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5
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Werbel WA, Durand CM. Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers. Curr HIV/AIDS Rep 2019; 16:191-203. [PMID: 31093920 PMCID: PMC6579039 DOI: 10.1007/s11904-019-00440-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW End-stage organ disease prevalence is increasing among HIV-infected (HIV+) individuals. Trial and registry data confirm that solid organ transplantation (SOT) is efficacious in this population. Optimizing access to transplant and decreasing complications represent active frontiers. RECENT FINDINGS HIV+ recipients historically experienced 2-4-fold higher rejection. Integrase strand transferase inhibitors (INSTIs) minimize drug interactions and may reduce rejection along with lymphodepleting induction immunosuppression. Hepatitis C virus (HCV) coinfection has been associated with inferior outcomes, yet direct-acting antivirals (DAAs) may mitigate this. Experience in South Africa and the US HIV Organ Policy Equity (HOPE) Act support HIV+ donor to HIV+ recipient (HIV D+/R+) transplantation. SOT is the optimal treatment for end-stage organ disease in HIV+ individuals. Recent advances include use of INSTIs and DAAs in transplant recipients; however, strategies to improve access to transplant are needed. HIV D+/R+ transplantation is under investigation and may improve access and provide insights for HIV cure and pathogenesis research.
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Affiliation(s)
- William A. Werbel
- Department of Medicine, Johns Hopkins University School
of Medicine, Baltimore, MD
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School
of Medicine, Baltimore, MD
- Sidney Kimmel Cancer Center, Johns Hopkins University
School of Medicine, Baltimore, MD
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6
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Pierrotti LC, Litvinov N, Costa SF, Azevedo LSFD, Strabelli TMV, Campos SV, Odongo FCA, Reusing-Junior JO, Song ATW, Lopes MIBF, Batista MV, Lopes MH, Maluf NZ, Caiaffa-Filho HH, de Oliveira MS, Sousa Marques HHD, Abdala E. A Brazilian university hospital position regarding transplantation criteria for HIV-positive patients according to the current literature. Clinics (Sao Paulo) 2019; 74:e941. [PMID: 30942282 PMCID: PMC6432843 DOI: 10.6061/clinics/2019/e941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection.Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.
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Affiliation(s)
- Lígia Camera Pierrotti
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Nadia Litvinov
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto da Crianca (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Silvia Figueiredo Costa
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Sérgio Fonseca de Azevedo
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Transplante Renal, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tânia Mara Varejão Strabelli
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Nucleo de Transplante Cardiaco, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Silvia Vidal Campos
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Pneumologia, Grupo de Transplante Pulmonar, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fatuma Catherine Atieno Odongo
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jose Otto Reusing-Junior
- Servico de Transplante Renal, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alice Tung Wan Song
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Max Igor Banks Ferreira Lopes
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marjorie Vieira Batista
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marta Heloisa Lopes
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Natalya Zaidan Maluf
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Imunologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hélio Helh Caiaffa-Filho
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Biologia Molecular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maura Salarolli de Oliveira
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Grupo Controle de Infeccao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Heloisa Helena de Sousa Marques
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto da Crianca (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edson Abdala
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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7
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Ailioaie O, Arzouk N, Valantin MA, Tourret J, Calin RO, Turinici M, Mircescu G, Barrou B. Infectious complications in HIV-infected kidney transplant recipients. Int J STD AIDS 2017; 29:341-349. [PMID: 28862528 DOI: 10.1177/0956462417726213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renal transplantation is now a viable alternative for dialysis in HIV-infected patients who achieve good immunovirological control with current antiretroviral therapy regimens available. However, there are few studies that analyze the incidence of post-transplant infections in this population. In this study, a retrospective analysis of data files of 24 HIV-infected kidney transplant (KT) recipients was undertaken, matched to 21 non-infected controls. All patients received induction with anti-interleukin-2 antibodies and were followed in the Pitié-Salpêtrière Hospital in Paris, France. The rate of incidence of post-transplant infections was 23.58 and 26.98/100 patient-years, in HIV-infected and HIV-negative groups (relative risk [RR]: 0.90; 95% confidence interval [CI]: 0.58-1.39; p = 0.63). In HIV-infected KT recipients, bacterial infections were the most frequent (67.7%), followed by viral (14.7%) and fungal and parasitic infections (8.8%). Similar trends were seen in the control group. Incidence of opportunistic infections was similar in HIV-infected KT recipients and controls (38.2 vs. 26.5%; p = 0.44). There were three post-transplant HIV reactivations in two patients, secondary to poor adherence to medication. HIV status did not influence survival, but infections increased the risk of unfavorable outcome. Incidence of post-transplant infections was similar in HIV-infected KT recipients and controls. Infections, but not HIV status, had adverse effects on patient and graft survival.
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Affiliation(s)
- O Ailioaie
- 1 Renal Transplant Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - N Arzouk
- 1 Renal Transplant Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - M A Valantin
- 2 Infectious Diseases Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - J Tourret
- 1 Renal Transplant Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - R O Calin
- 2 Infectious Diseases Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - M Turinici
- 3 Biostatistics Department, 26930 Public Assistance of Paris Hospitals , Paris, France
| | - G Mircescu
- 4 "Dr. C. Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - B Barrou
- 1 Renal Transplant Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
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8
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Agüero F, Castel MA, Cocchi S, Moreno A, Mestres CA, Cervera C, Pérez-Villa F, Tuset M, Cartañà R, Manzardo C, Guaraldi G, Gatell JM, Miró JM. An Update on Heart Transplantation in Human Immunodeficiency Virus-Infected Patients. Am J Transplant 2016; 16:21-8. [PMID: 26523614 DOI: 10.1111/ajt.13496] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 01/25/2023]
Abstract
Cardiovascular diseases have become a significant cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Heart transplantation (HT) is a well-established treatment of end-stage heart failure (ESHF) and is performed in selected HIV-infected patients in developed countries. Few data are available on the prognosis of HIV-infected patients undergoing HT in the era of combined antiretroviral therapy (cART) because current evidence is limited to small retrospective cohorts, case series, and case reports. Many HT centers consider HIV infection to be a contraindication for HT; however, in the era of cART, HT recipients with HIV infection seem to achieve satisfactory outcomes without developing HIV-related events. Consequently, selected HIV-infected patients with ESHF who are taking effective cART should be considered candidates for HT. The present review provides epidemiological data on ESHF in HIV-infected patients from all published experience on HT in HIV-infected patients since the beginning of the epidemic. The practical management of these patients is discussed, with emphasis on the challenging issues that must be addressed in the pretransplant (including HIV criteria) and posttransplant periods. Finally, proposals are made for future management and research priorities.
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Affiliation(s)
- F Agüero
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M A Castel
- Heart Failure and Heart Transplant Unit, Cardiology Department, Thorax Institut, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - S Cocchi
- Clinic of Infectious Diseases, Department of Internal Medicine and Medical Specialties, University of Modena and Reggio Emilia, Policlinico Hospital, Modena, Italy
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C A Mestres
- Cardiovascular Surgery Department, Thorax Institute Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Cervera
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Thorax Institut, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Tuset
- Pharmacy Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - R Cartañà
- Cardiovascular Surgery Department, Thorax Institute Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - G Guaraldi
- Clinic of Infectious Diseases, Department of Internal Medicine and Medical Specialties, University of Modena and Reggio Emilia, Policlinico Hospital, Modena, Italy
| | - J M Gatell
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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9
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Joshi D, Agarwal K. Role of liver transplantation in human immunodeficiency virus positive patients. World J Gastroenterol 2015; 21:12311-12321. [PMID: 26604639 PMCID: PMC4649115 DOI: 10.3748/wjg.v21.i43.12311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/04/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
End-stage liver disease (ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus (HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus (HCV) infection, drug-induced hepatotoxicity related to combined anti-retro-viral therapy, alcohol related liver disease and non-alcohol related fatty liver disease appear to be the leading causes. It is therefore, anticipated that more HIV-positive patients with ESLD will present as potential transplant candidates. HIV infection is no longer a contraindication to liver transplantation. Key transplantation outcomes such as rejection and infection rates as well as medium term graft and patient survival match those seen in the non-HIV infected patients in the absence of co-existing HCV infection. HIV disease does not seem to be negatively impacted by transplantation. However, HIV-HCV co-infection transplant outcomes remain suboptimal due to recurrence. In this article, we review the key challenges faced by this patient cohort in the pre- and post-transplant period.
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10
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Xenozoonoses. LABORATORY ANIMAL MEDICINE 2015. [PMCID: PMC7150069 DOI: 10.1016/b978-0-12-409527-4.00029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immunological and technical advances have led to tremendous increases in the number of people potentially able to benefit from allotransplantation. Ironically, it is the success of the field that has led to a renewed interest in xenotransplantation during the past several decades. To a large part, this has occurred because of the great scarcity of human organ and tissue donors. However, it has expanded to include the use of cells from animals into humans such as porcine islet cells for diabetes or extracorporeal perfusion of human blood through animal organs or cells. Similar to allotransplantation, issues regarding transmission of infections from the graft to the human recipient were brought up for consideration with these procedures in the 1990s (Michaels and Simmons, 1994; Chapman et al., 1995; Hammel et al., 1998; Fishman et al., 1998). A risk for infection exists with the use of any biologic agent regardless of whether it is from a human or an animal source. Accordingly, transmission of infections from human organs, tissues, or cells is a well-recognized cause of disease after allotransplantation (Ison and Grossi, 2013; Green and Michaels, 2012). As the human graft shortage continues, newer cellular therapies are explored. Thus, attention continues to be given to the potential use of xenogeneic organs, tissues, or cells for human maladies through xenotransplantation. The potential for novel zoonotic infections to emerge because of xenotransplantation (xenozoonoses or xenosis) led to a debate on whether the field should be permitted to progress. This chapter reviews the issues of xenotransplantation related to infections from animals to humans. Lessons learned from infections with prior nonhuman primate xenotransplantation and human allotransplantation are used to help inform about risks with newer xenogeneic procedures. In addition, information on known zoonoses is reviewed to better develop constructs to decrease the hazard of infection with these novel procedures.
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11
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Kostakis I, Sotiropoulos G, Kouraklis G. Pneumocystis jirovecii Pneumonia in Liver Transplant Recipients: A Systematic Review. Transplant Proc 2014; 46:3206-8. [DOI: 10.1016/j.transproceed.2014.09.156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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13
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14
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Shafer TJ, Schkade D, Schkade L, Geier SS, Orlowski JP, Klintmalm G. Zero risk tolerance costs lives: loss of transplantable organs due to human immunodeficiency virus nucleic acid testing of potential donors. Prog Transplant 2011. [PMID: 21977885 DOI: 10.7182/prtr.21.3.w5068r3561qx56t6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients' deaths due to the organ donor shortage make it imperative that every suitable organ be transplanted. False-positive results of tests for infection with the human immunodeficiency virus (HIV) result in lost organs. A survey of US organ procurement organizations collected the numbers of donors and ruled-out potential donors who had a positive result on an HIV test from January 1,2006, to October 31, 2008. Sixty-two percent of US organ procurement organizations participated. Of the 12397 donor/nondonor cases, 56 (0.45%) had an initial positive result on an HIV antibody or HIV nucleic acid test, and only 8 (14.3%) of those were confirmed positive. Of the false-positive results, 50% were from HIV antibody tests and 50% were from HIV nucleic acid tests. Organs are a scarce, finite, and perishable resource. Use of HIV antibody testing has produced a remarkably safe track record of avoiding HIV transmission, with 22 years of nonoccurrence between transmissions. Because false positives occur with any test, including the HIV Ab test, adding nucleic acid testing to the standard donor testing panel doubles the number of false-positive HIV test results and thus the number of medically suitable donors lost. The required HIV antibody test is 99.99% effective in preventing transmission of the HIV virus. Adding the HIV nucleic acid test to routine organ donor screening could result in as many as 761 to 1551 unnecessary deaths of patients between HIV transmission events because medically suitable organs are wasted.
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Affiliation(s)
- Teresa J Shafer
- LifeGift Organ Donation Center, 1701 River Run, Suite 300, Fort Worth, TX 76107, USA.
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15
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Zero Risk Tolerance Costs Lives: Loss of Transplantable Organs Due to Human Immunodeficiency Virus Nucleic Acid Testing of Potential Donors. Prog Transplant 2011; 21:236-47; quiz 248. [DOI: 10.1177/152692481102100309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Joshi D, O'Grady J, Taylor C, Heaton N, Agarwal K. Liver transplantation in human immunodeficiency virus-positive patients. Liver Transpl 2011; 17:881-90. [PMID: 21563295 DOI: 10.1002/lt.22329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the successful introduction of combined antiretroviral therapy (cART), human immunodeficiency virus (HIV) is now regarded as a chronic illness with excellent long-term outcomes. However, chronic exposure to viral etiologies (ie, chronic hepatitis B and hepatitis C) and drug-induced toxicity secondary to cART have resulted in increasing rates of mortality and morbidity due to end-stage liver disease. HIV disease is no longer considered an absolute contraindication to liver transplantation (LT) by most transplant centers worldwide. Because the burden of liver disease in this cohort is likely to increase, this review addresses the key etiologies and the management strategies available for HIV-positive patients undergoing LT.
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Affiliation(s)
- Deepak Joshi
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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17
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Viale P, Baccarani U, Tavio M. Liver transplant in patients with HIV: infection risk associated with HIV and post-transplant immunosuppression. Curr Infect Dis Rep 2010; 10:74-81. [PMID: 18377819 DOI: 10.1007/s11908-008-0013-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Before the introduction of highly active antiretroviral therapy, HIV-infected patients who underwent liver transplantation (LT) had poor survival, mainly because of a rapid progression to AIDS and its infectious complications during the post-LT immunosuppression phase. However, in the era of highly active antiretroviral therapy, under some specific and well-determined conditions, LT might be as safe and efficacious in HIV patients as it is in non-HIV-infected patients. End-stage liver failure as caused by hepatitis B virus, cirrhosis, and hepatotoxicity should be considered indications for LT in every transplant center. Because of the almost universal hepatitis C virus reinfection and its accelerated course post-LT, LT in hepatitis C virus-coinfected patients deserves more caution and more extended follow-up before it is accepted as a standard indication for LT in HIV-infected patients.
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Affiliation(s)
- Pierluigi Viale
- Azienda Ospedaliero-Universitaria di Udine, via Colugna, 50 - 33100 Udine, Italy
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18
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Huprikar S. Solid organ transplantation in HIV-infected individuals: an update. Rev Med Virol 2010; 19:317-23. [PMID: 19554551 DOI: 10.1002/rmv.620] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the era of highly active antiretroviral therapy (HAART), the survival of patients with HIV has improved. Increasing morbidity and mortality are now related to chronic liver and kidney disease. Transplantation in HIV patients has been reported for nearly two decades and outcomes have generally improved in the HAART era. This review summarises the published experiences with liver and kidney transplantation in HIV patients.
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Affiliation(s)
- Shirish Huprikar
- Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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19
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20
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Miller WV. Tissue banking articles in the journal TRANSFUSION. Transfusion 2009. [DOI: 10.1111/j.1537-2995.1993.tb05760.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Roland ME, Barin B, Carlson L, Frassetto LA, Terrault NA, Hirose R, Freise CE, Benet LZ, Ascher NL, Roberts JP, Murphy B, Keller MJ, Olthoff KM, Blumberg EA, Brayman KL, Bartlett ST, Davis CE, McCune JM, Bredt BM, Stablein DM, Stock PG. HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes. Am J Transplant 2008; 8:355-65. [PMID: 18093266 DOI: 10.1111/j.1600-6143.2007.02061.x] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Improvements in human immunodeficiency virus (HIV)-associated mortality make it difficult to deny transplantation based upon futility. Outcomes in the current management era are unknown. This is a prospective series of liver or kidney transplant recipients with stable HIV disease. Eleven liver and 18 kidney transplant recipients were followed for a median of 3.4 years (IQR [interquartile range] 2.9-4.9). One- and 3-year liver recipients' survival was 91% and 64%, respectively; kidney recipients' survival was 94%. One- and 3-year liver graft survival was 82% and 64%, respectively; kidney graft survival was 83%. Kidney patient and graft survival were similar to the general transplant population, while liver survival was similar to the older population, based on 1999-2004 transplants in the national database. CD4+ T-cell counts and HIV RNA levels were stable; and there were two opportunistic infections (OI). The 1- and 3-year cumulative incidence (95% confidence intervals [CI]) of rejection episodes for kidney recipients was 52% (28-75%) and 70% (48-92%), respectively. Two-thirds of hepatitis C virus (HCV)-infected patients, but no patient with hepatitis B virus (HBV) infection, recurred. Good transplant and HIV-related outcomes among kidney transplant recipients, and reasonable outcomes among liver recipients suggest that transplantation is an option for selected HIV-infected patients cared for at centers with adequate expertise.
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Affiliation(s)
- M E Roland
- University of California, San Francisco, CA, USA.
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22
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Abstract
Survival rates after liver transplantation have improved steadily because of earlier referral and timely evaluation, judicious patient selection, improved surgical techniques, superior immunosuppressive regimens, and effective prevention of perioperative opportunistic infections. Indications and contraindications for liver transplantation are undergoing constant modifications with the goal of improving survival and functional status of patients who have end-stage liver disease or acute liver failure. Potential candidates for liver transplantation should meet minimal listing criteria and not have contraindications to liver transplantation. Currently, the Model for End-stage Liver Disease score is used for organ allocation, but it may have future application in patient-selection criteria.
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Affiliation(s)
- Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Liver Transplant Program, Stanford University School of Medicine, Stanford, CA 94304, USA
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23
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Roland ME, Stock PG. Solid organ transplantation is a reality for patients with HIV infection. Curr HIV/AIDS Rep 2006; 3:132-8. [PMID: 16970840 DOI: 10.1007/bf02696657] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Recent policies, guidelines, and laws reflect promising preliminary outcomes among transplant recipients with HIV infection, and ethical analyses suggest that it is not justifiable to deny solid organ transplantation based solely on HIV-infection status. These studies consistently describe stable HIV disease following liver and kidney transplantation. Despite good graft survival, kidney allograft rejection occurs frequently, and serious non-AIDS-defining infections requiring hospitalization are common following antirejection therapy. Profound interactions between immunosuppressants and antiretroviral drugs require careful monitoring, dose adjustment, and highly effective communication between the patient and a multidisciplinary group of health care providers. Despite these scientific and policy advances, many health care providers and patients remain unaware of ongoing progress in this field. The implications are critical, as late referral for liver transplant evaluation increases the pretransplant mortality risk. Because important patient selection and clinical management questions remain, it is critical that ongoing studies are completed quickly.
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Affiliation(s)
- Michelle E Roland
- Department of Medicine, University of California, Positive Health Program (AIDS Division) at San Francisco General Hospital, Ward 84, Building 80, 995 Potrero Avenue, San Francisco, CA 94110, USA.
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24
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Qiu J, Terasaki PI, Waki K, Cai J, Gjertson DW. HIV-positive renal recipients can achieve survival rates similar to those of HIV-negative patients. Transplantation 2006; 81:1658-61. [PMID: 16794531 DOI: 10.1097/01.tp.0000226074.97314.e0] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although patients positive for HIV were once thought to be unsuitable candidates for kidney transplantation, their increasing numbers with end-stage renal disease (ESRD) and the introduction of highly active antiretroviral therapy has indicated that they should no longer be excluded for transplantation. To counteract suggestions that human immunodeficiency virus (HIV) patients received suboptimal kidneys, we provide studies of kidneys transplanted from the same donor into patients with and without HIV. METHODS United Network for Organ Sharing kidney transplant data between 1997 and 2004 were analyzed. Graft and patient survival of 38 HIV patients who had received a renal transplant were compared with the survival of 38 recipients who had received a graft from the same donor. RESULTS The 38 HIV-positive recipients were younger (49.0 vs. 52.3 years, P=0.14) and had lower peak panel-reactive antibodies (PRA; 5.1% vs. 15.6%, P=0.07) when compared with their bilateral donor to HIV-negative recipients. Sirolimus was used more frequently in HIV patients than in non-HIV patients (36.8% vs. 23.7%, P=0.09). The serum creatinine at 1, 3, and 5 years posttransplantation were higher in HIV patients when compared to non-HIV patients. Although not statistically significant, graft survival was higher among HIV-positive patients compared with their negative controls (76.1% vs. 65.1% at 5 years, P=0.21), as was patient survival (91.3% vs. 87.3% at 5 years, P=0.72). More grafts failed due to death with a functioning graft than rejection in HIV-positive patients. CONCLUSION This study supports the position that there is no longer an ethical question surrounding the use of kidneys for HIV-positive patients.
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Affiliation(s)
- Jianxin Qiu
- Terasaki Foundation Laboratory, Los Angeles, CA 90064, USA.
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25
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Garrity ER, Boettcher H, Gabbay E. Donor infection: an opinion on lung donor utilization. J Heart Lung Transplant 2006; 24:791-7. [PMID: 15982604 PMCID: PMC7118468 DOI: 10.1016/j.healun.2004.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Revised: 04/29/2004] [Accepted: 05/09/2004] [Indexed: 01/15/2023] Open
Affiliation(s)
- Edward R Garrity
- Department of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, Illinois 60153-5586, USA.
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26
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Abstract
Human immunodeficiency virus (HIV) infection has traditionally been considered an absolute contraindication to solid organ transplantation. With improvements in survival and increases in the prevalence of end-stage liver and kidney disease in HIV-positive patients treated with highly active antiretroviral therapy, many transplant centers have begun to reconsider the role of transplantation in patients with well-controlled HIV infection. This article reviews the literature on transplantation in HIV-infected patients, with a focus on kidney transplantation in the era of highly active antiretroviral therapy.
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Affiliation(s)
- Christina M Wyatt
- Division of Nephrology, Mount Sinai School of Medicine, New York, New York 10029, USA
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27
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Radecke K, Frühauf NR, Miller M, Ross B, Köditz R, Malagó M, Broelsch CE, Gerken G, Treichel U. Outcome after orthotopic liver transplantation in five HIV-infected patients with virus hepatitis-induced cirrhosis. Liver Int 2005; 25:101-8. [PMID: 15698406 DOI: 10.1111/j.1478-3231.2005.01031.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND We report on our experiences with orthotopic liver transplantation (OLT) in HIV-infected patients. Between July 1998 and October 2001, five HIV-infected patients underwent OLT because of virus-induced liver cirrhosis. One patient suffered from hepatitis B virus (HBV)-, three patients from hepatitis C virus (HCV)- and one patient from HCV/HBV/HDV-related cirrhosis (HDV, hepatitis D virus). The mean duration of HIV infection was 15 years. Patients were prospectively followed up with a mean duration of 25.6 months. RESULTS Three patients died 3, 10 and 31 months after OLT, respectively, due to graft failure. The causes of graft failure were: recurrent thrombosis of the hepatic artery, HCV-associated cholestatic hepatitis and chemotherapy-induced liver damage due to Hodgkin's disease, which was diagnosed 17 months after OLT, in addition to chronic HCV disease. The two survivors show a stable liver function and non-progredient HIV infection under antiretroviral therapy 61 and 23 months after OLT, respectively. CONCLUSIONS A medium- or even long-term survival after OLT can be achieved in HIV-infected patients without progression of HIV disease under antiretroviral therapy. However, in our study three out of five patients died due to graft failure. Therefore, prognostic criteria have to be defined for the selection of HIV-infected patients, who may benefit from OLT.
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Affiliation(s)
- Klaus Radecke
- Department of Gastroenterology and Hepatology, University Hospital Essen, 45147 Essen, Germany
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28
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Neff GW, Sherman KE, Eghtesad B, Fung J. Review article: current status of liver transplantation in HIV-infected patients. Aliment Pharmacol Ther 2004; 20:993-1000. [PMID: 15569101 DOI: 10.1111/j.1365-2036.2004.02232.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The increases in survival of patients infected with human immunodeficiency virus is attributed to the introduction of combination human immunodeficiency virus antiviral therapy, better known as highly active anti-retroviral therapy. In fact, survival statistics have improved such that individuals often succumb to other disease entities, notably liver failure and not from acquired immunodeficiency syndrome complications. Liver transplantation has been introduction in this patient population in several centres around the world. This review will discuss the current clinical status of liver transplantation in individuals suffering from human immunodeficiency virus infection.
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Affiliation(s)
- G W Neff
- Division of Digestive Diseases, University of Cincinnati, OH, USA.
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29
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Frühauf NR, Köditz R, Radecke K, Malagó M, Lang H, Broelsch CE. [Organ transplantation in human immunodeficiency virus-infected patients. Results of a survey in German transplantation centres]. Chirurg 2004; 75:681-6. [PMID: 15258750 DOI: 10.1007/s00104-004-0825-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite considerable advances following the introduction of highly active antiretroviral therapy, organ transplantation is usually denied categorically for human immunodeficiency virus (HIV) patients, and it is presented in German transplantation law as a contraindication. Today, this should be questioned critically. METHOD A survey at all 87 German transplant centres was done concerning (1) how many HIV-positive patients were transplanted before and after February 2000, (2) willingness of the centres to transplant HIV-infected patients in the future, and (3) course of transplanted HIV patients so far. RESULTS With a response rate of 78%, 39% of the questioned centres were accepting HIV patients in the future for transplantation, and 39% rejected this. Twenty percent voted for individual case decision. Three centres had practiced liver transplantation in 11 patients. CONCLUSION The decision to transplant HIV-positive patients in Germany is mostly based on individual cases and not refused in general. However, prospective studies on this issue are justified and needed.
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Affiliation(s)
- N R Frühauf
- Klinik für Allgemein- und Transplantationschirurgie, Universitätsklinikum Essen, Essen
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30
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de la Mata M, Barrera P, Fraga E, Montero JL, de la Torre J, López-Cillero P, Briceño J, Solórzano G, Alonso M. [Liver transplantation in patients with HIV infection]. GASTROENTEROLOGIA Y HEPATOLOGIA 2004; 27:425-8. [PMID: 15461943 DOI: 10.1016/s0210-5705(03)70492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M de la Mata
- Unidad de Trasplante Hepático, Hospital Universitario Reina Sofía, Córdoba, Spain.
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31
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Fung J, Eghtesad B, Patel-Tom K, DeVera M, Chapman H, Ragni M. Liver transplantation in patients with HIV infection. Liver Transpl 2004; 10:S39-53. [PMID: 15382219 DOI: 10.1002/lt.20261] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
1. Liver transplantation for human immunodeficiency virus (HIV)-positive patients with end-stage liver disease in the era of highly active retroviral therapy has proven to be an effective treatment. The concerns of HIV progression have not been borne out by the growing worldwide experience. 2. CD4 counts are stable and HIV viral load is controllable with medication following liver transplantation. 3. Hepatitis C virus (HCV) coinfection in HIV-positive recipients is universal, but the severity of recurrence does not appear to be different from that in HIV-negative patients with HCV liver disease. 4. Complex pharmacokinetic interactions between the calcineurin inhibitors used for immunosuppression along with protease inhibitors are present, but management directed at recognizing the need for monitoring levels does not appear to increase the risk of toxicity. 5. The degree of immunosuppression from iatrogenic drug therapy and HIV does not lead to increased risk of infectious complications.
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Affiliation(s)
- John Fung
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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32
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Abstract
HIV is generally regarded as an acceptable reason to exclude a potential recipient from consideration for transplantation. Most of the data in the literature regarding transplantation of HIV sero-positive individuals pertains to the time prior to the administration of Highly Active Anti-Retroviral Therapy (pre-HAART). This data, therefore, provides little guidance for the management of HIV-positive individuals in the current era. The development of HAART has resulted in a decreased mortality. With prolonged survival more HIV-infected individual are developing end stage organ disease from co-existing conditions such as HCV and HBV, and diseases common in the general population such as diabetes mellitus and hypertension. This has lead to clinicians, researchers and patients to actively investigate the role of solid organ transplantation in HIV-infected individuals. In this article We review the literature to date in liver and renal transplantation, including more recent data in patients receiving HAART.
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Affiliation(s)
- Suzanne El Sayegh
- Division of Nephrology, Mount Sinai School of Medicine, New York 10029, USA
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33
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Miró JM, Montejo M, Rufí G, Bárcena R, Vargas V, Rimola A, Bañares R, Valdivieso A, Fabregat J, Vicente ED, Margarit C, Moreno A, Miralles P, Aguirrebengoa K, Xiol FX, Fortún J, Pahissa A, Laguno M, Salcedo M, Cisneros JM, Quereda C, Tuset M, Castón JJ, Torre-Cisneros J. Trasplante hepático en pacientes con infección por el VIH: una realidad en el año 2004. Enferm Infecc Microbiol Clin 2004; 22:529-38. [PMID: 15511394 DOI: 10.1016/s0213-005x(04)73155-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
According to current estimates, there are 60,000 to 80,000 HIV and HCV coinfected individuals in Spain, and 5,000 to 10,000 HIV and HBV coinfected individuals. Among these patients, 10% to 15% have liver cirrhosis. Thus, end-stage liver disease is one of the major causes of death in our country. Liver transplantation is the only therapeutic option for these patients. Accumulated experience in North America and Europe in the last five years indicates that three-year survival in HIV-positive liver transplant recipients is similar to that of HIV-negative recipients. The selection criteria for HIV transplant candidates includes the following: no history of opportunistic infections, CD4 lymphocyte count higher than 100 cells/mm3, and HIV viral load suppressible with antiretroviral treatment. In Spain, where the majority of patients are former drug abusers, complete abstinence from heroin or cocaine use during two years is also required, with the possibility of the patient being in a methadone program. To date 26 hepatic transplants have been performed in the same number of patients, with only two deaths (7%) after a median follow-up of eight months (1-28). The main problems in the post-transplantation period in all the series has been recurrent HCV infection, which is the principle cause of post-transplantation mortality, and pharmacokinetic and pharmacodynamic interactions between the antiretroviral and immunosuppressive agents. There is little experience with pegylated interferon and ribavirin treatment in this population.
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Affiliation(s)
- José M Miró
- Hospital Clínic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain.
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34
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35
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Abstract
Human immunodeficiency virus (HIV) infection in patients with end-stage renal disease (ESRD) offers many diagnostic and therapeutic challenges to nephrologists. Renal failure may be a direct consequence of viral infection (HIV-associated nephropathy), or intrinsic renal diseases may occur in previously infected individuals. Patients receiving renal replacement therapy (RRT) may acquire HIV infection from blood transfusions, renal allografts, sexual contacts, or needle sharing by drug addicts. In the early 1980s, the overall prognosis of patients with the acquired immunodeficiency syndrome (AIDS) was very poor, and survival of those with ESRD was dismal. Consequently many even questioned the value of providing maintenance dialysis to patients with AIDS. With advances in diagnostic techniques in serologic and viral markers of disease, and deployment of highly effective antiretroviral agents, the prognosis of HIV-infected patients has dramatically improved. Over the past two decades, experiences in the management of HIV patients with ESRD is accumulating. Both peritoneal dialysis and hemodialysis are effective modes of therapy and many centers are now beginning to perform renal transplantation in HIV-infected patients. This article deals with various aspects of HIV infection in patients with ESRD.
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Affiliation(s)
- T K Sreepada Rao
- Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.
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36
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Abstract
Infection occurs when microbial agents enter the host, either through airborne transmission or by direct contact of a substance carrying the infectious agent with the host. Human body fluids, solid organs, or other tissues often are ideal vectors to support microbial agents and can transmit infections efficiently from donor to recipient. In the case of blood transfusion and tissue transplantation, the main consequence of such a transmission is infection of the recipient. However, in the case of solid-organ transplantation, and particularly for liver transplantation, donor infections are not only transmitted to the recipient, the donor infection also may affect the donated liver's preservability and subsequent function in the recipient irrespective of the systemic consequences of the infection. In addition, solid organ recipients of infected organs are less able to respond to the infectious agent because of their immunosuppressive treatment. Thus, transmission of infections from organ donor to liver recipient represents serious potential risks that must be weighed against a candidate's mortality risk without the transplant. However, the ever-increasing gap between the number of donors and those waiting for liver grafts makes consideration of every potential donor, regardless of the infection status, essential to minimize waiting list mortality. In this review, we will focus on assessing the risk of transmission of bacterial, fungal, viral, and parasitic infectious agents from cadaveric liver donors to recipients and the effect such a transmission has on liver function, morbidity, and mortality. We will also discuss risk-benefit deliberations for using organs from infected donors for certain types of recipients. These issues are critically important to maximize the use of donated organs but also minimize recipient morbidity and graft dysfunction.
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Affiliation(s)
- Michael Angelis
- Division of Transplantation, Tufts-New England Medical Center, Boston, MA 02111, USA
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37
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Neff GW, Bonham A, Tzakis AG, Ragni M, Jayaweera D, Schiff ER, Shakil O, Fung JJ. Orthotopic liver transplantation in patients with human immunodeficiency virus and end-stage liver disease. Liver Transpl 2003; 9:239-47. [PMID: 12619020 DOI: 10.1053/jlts.2003.50054] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with human immunodeficiency virus (HIV) most often have hepatitis C virus (HCV) or hepatitis B (HBV) virus coinfection, or both, as a cause of their liver disease. Recent survival statistics show that patients infected with HIV treated with highly active antiretroviral therapy (HAART) can expect a significant prolongation of life by interfering with the natural progression of HIV to acquired immune deficiency syndrome (AIDS). Therefore, HIV-positive patients experiencing complications of liver failure are at greater immediate risk of dying from their end-stage liver disease (ESLD) rather than their HIV. Many transplant centers still consider HIV infection as a contraindication for orthotopic liver transplantation (OLT). At our two institutions, we believe that patients with HIV suffering from ESLD should be considered for OLT. This study evaluates the survival of patients undergoing OLT with HIV under HAART therapy. OLT was performed in 16 patients with HIV suffering from ESLD as a result of chronic HCV, chronic HBV, or fulminant hepatic failure (FHF). Collected data include patient demographics, patient and graft survival, pre-OLT assessments, and postoperative complications (including opportunistic infections). Ten patients at Pittsburgh and 6 patients at Miami received OLT. Of the 16 patients who received OLT, 14 remain alive to date. Thirteen of 16 patients are more than 12 months post-OLT, whereas the last patient is currently 6 months post-OLT. Five patients at Miami and 9 of 10 patients at Pittsburgh received HAART therapy before OLT, although 2 of the Pittsburgh patients had their HAART therapy discontinued before OLT because of significant liver dysfunction. The pre-OLT viral loads were undetectable in 13 of 16 patients. The cluster determinant (CD)4 count was less than 200 in 6 patients and greater than 100 in 2 patients before OLT. In all patients, CD4 counts increased above 200 in the post-OLT period. Tacrolimus toxicity associated with the pharmacologic inhibition of cytochrome p450 metabolism caused by protease inhibitors occurred in 6 patients after OLT. Six patients (38%) experienced acute cellular rejection immediately after OLT. Our experience suggests that OLT is effective in selected HIV-positive patients suffering from ESLD. Patient and graft survival was similar to non-HIV-positive patients suffering from the same indications for OLT. Acute cellular rejection was no less frequent that seen in non-HIV-positive patients. Given the complex pharmacologic interactions between the protease inhibitors and tacrolimus, careful monitoring, and attention is required to prevent toxicity or underdosing.
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Affiliation(s)
- Guy W Neff
- Department of Medicine, Division of GI Transplant, University of Miami, Miami, FL 33136, USA.
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38
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Nowak P, Schvarcz R, Ericzon BG, Flamholc L, Sönnerborg A. Follow-up of antiretroviral treatment in liver transplant recipients with primary and chronic HIV type 1 infection. AIDS Res Hum Retroviruses 2003; 19:13-9. [PMID: 12581512 DOI: 10.1089/08892220360473925] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prognosis of HIV-1-infected patients has dramatically improved but progression to liver failure occurs now frequently in subjects coinfected with hepatitis C virus (HCV). This has raised the issue of organ transplantation, but the knowledge about the effect of concomitant antiretroviral and immunosuppressive therapy is limited. The objective of the study was to describe viral and immunological events in antiretroviral-treated orthotopic liver transplant (OLT) recipients with primary (PHI) or chronic HIV-1 infection. Three HIV-1-infected patients with liver cirrhosis due to chronic HCV infection underwent OLT. A fourth patient developed PHI at OLT. Immunosuppressive drugs and combination antiretroviral therapy were given. The effects on HIV-1 load, viral diversity and divergence, and CD4(+) T cell counts, were studied. One patient died after 3 months. Three subjects were alive after 9 months, 14 months, and 3 years, respectively. In the PHI patient, viral load decreased during the second week of illness despite immunosuppression. During the third week the viremia increased until antiretroviral treatment was initiated. In all four patients, the HIV-1 replication was effectively inhibited during follow-up by the treatment, as determined by undetectable plasma viremia, lack of viral sequence changes, and increase in CD4(+) T cells. The pattern of viral dynamics may suggest that the innate immunity causes the earliest decline of viral load in PHI patients. A lack of adaptive immunity may thereafter lead to an increase in viremia in heavily immunosuppressed individuals. However, a specific HIV-1 immunity is not necessary to efficiently inhibit the viral replication when potent antiretroviral therapy is given in liver transplant recipients with primary or chronic HIV-1 infection.
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Affiliation(s)
- Piotr Nowak
- Division of Clinical Virology, Huddinge University Hospital, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
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Affiliation(s)
- Scott D Halpern
- University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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Prachalias AA, Pozniak A, Taylor C, Srinivasan P, Muiesan P, Wendon J, Cramp M, Williams R, O'Grady J, Rela M, Heaton ND. Liver transplantation in adults coinfected with HIV. Transplantation 2001; 72:1684-8. [PMID: 11726833 DOI: 10.1097/00007890-200111270-00020] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report our experience of prospectively identifying and transplanting livers into HIV-positive patients. DESIGN Liver transplantation in HIV-positive patients remains controversial. The finding of HIV is usually considered a contraindication to any form of transplantation. Previously reported cases are few and refer to patients who tested HIV positive after they had their liver transplantations or who seroconverted in the posttransplantation period. This is, to our knowledge, the only report of patients who were known to be HIV positive at the time of decision for listing for transplantation. METHODS The medical records of five HIV-positive patients who received liver transplants in King's College Hospital, London, during a 5-year period (January 1995-December 1999) were reviewed. All five were known to be HIV positive at the time of listing for liver replacement. Three of them had end-stage liver disease due to hepatitis C (two of them had underlying Hemophilia A) while the other two had acute liver failure, one due to hepatitis B infection and one due to nonA-nonB-nonC hepatitis. In all but one patient the HIV infection had been asymptomatic. RESULTS All patients survived the immediate posttransplantation period, but the three patients with hepatitis C died of complications of recurrent hepatitis C between 6 and 25 months posttransplantation. The other two patients are currently alive 4 and 34 months posttransplantation with good graft function and without complications from their HIV infection. CONCLUSION The early outcome of liver transplantation in HIV seropositive patients can be good, and patients should not be excluded from transplantation if their liver disease determines their prognosis. More effective antiviral therapy for hepatitis C given posttransplantation, and for hepatitis B reinfection, should improve the longer-term outcome of HIV patients with end-stage liver disease due to hepatitis.
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Affiliation(s)
- A A Prachalias
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
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Affiliation(s)
- P J Gow
- Liver and Hepatobiliary Unit, Third Floor, Nuffield House, Queen Elizabeth Hospital, Birmingham, England
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Fishman JA, Rubin RH. Solid organ transplantation in HIV-infected individuals: obstacles and opportunities. Transplant Proc 2001; 33:1310-4. [PMID: 11267303 DOI: 10.1016/s0041-1345(00)02488-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J A Fishman
- Transplant Infectious Disease Program, Infectious Disease Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Thamer M, Hwang W, Fink NE, Sadler JH, Bass EB, Levey AS, Brookmeyer R, Powe NR. U.S. nephrologists' attitudes towards renal transplantation: results from a national survey. Transplantation 2001; 71:281-8. [PMID: 11213074 DOI: 10.1097/00007890-200101270-00020] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renal transplantation is the optimal treatment for persons with end-stage renal disease (ESRD). A shortage of kidneys in the U.S. has focused increasing attention on the process by which kidneys are allocated. A national survey was undertaken to determine the relative importance of both clinical and nonclinical factors in the recommendation for renal transplantation by U.S. nephrologists. METHODS We conducted a national random survey of 271 U.S. nephrologists using hypothetical patient scenarios to determine their recommendation for renal transplantation based on demographic, clinical, and social factors. Specifically, eight unique patient scenarios were randomly distributed to each survey respondent. RESULTS According to responding nephrologists (response rate 53%), females were less likely than males to be recommended for renal transplantation [adjusted odds ratio (OR)=0.41; confidence interval (CI) 0.21, 0.79; for whites]. Asian males were less likely than white males to be recommended for transplantation (OR=0.46, CI 0.24, 0.91). Black-white differences in rates of recommendation were not found. Other factors associated with low rates of recommendation for renal transplantation included history of noncompliance (OR=0.17, CI 0.13, 0.23), <25% cardiac ejection fraction (OR=0.15, CI 0.10, 0.21), HIV infection (OR=0.01, CI 0.00, 0.01), and being >200 lbs (OR=0.73, CI 0.56, 0.95). CONCLUSIONS Female gender, and Asian but not black race, were associated with a decreased likelihood that nephrologists would recommend renal transplantation for patients with end stage renal disease. The well-documented black-white disparities in use of renal transplantation may be due to unaccounted for factors or may arise at a subsequent step in the transplantation process.
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Affiliation(s)
- M Thamer
- Department of Health Policy and Management, Johns Hopkins Medical Institutions, Independent Dialysis Foundation, Baltimore, MD, USA
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Simpson KJ, Garden OJ. Letter. J R Coll Physicians Edinb 1999. [DOI: 10.1177/147827159902900424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Infection in transplantation results from interaction between the level of immune suppression and the epidemiologic exposures of the recipient. "Xenosis," infection in xenotransplantation, may be increased beyond that of allotransplantation because: (1) the xenograft may serve as a permissive focus of infection for donor-derived organisms; (2) these organisms may be unknown or xenotropic; (3) microbiologic assays may be unavailable; (4) clinical syndromes due to such novel pathogens may not be recognized; (5) the necessary level of immune suppression may be greater than for allotransplantation; (6) donor-derived organisms may acquire new (e.g., genetic) characteristics in the human host; (7) the presence of immune suppression and the high, intrinsic rate of infection may mask the presence of xenosis; and (8) MHC-incompatibility may reduce the efficacy of the immune response within the xenograft. Because immunocompromised individuals are sentinels for infection by many types of novel infectious agents, and because there is some unknown level of risk that such pathogens will spread to the general population, microbiologic studies must be initiated in tandem with preclinical and clinical studies of xenotransplantation.
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Affiliation(s)
- J A Fishman
- Infectious Disease Unit, Massachusetts General Hospital, Boston, USA.
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Spital A. Should all human immunodeficiency virus-infected patients with end-stage renal disease be excluded from transplantation? The views of U.S. transplant centers. Transplantation 1998; 65:1187-91. [PMID: 9603166 DOI: 10.1097/00007890-199805150-00008] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected patients have generally been excluded from transplantation. Recent advances in the management and prognosis of these patients suggest that this policy should be reevaluated. METHODS To explore the current views of U.S. transplant centers toward transplanting asymptomatic HIV-infected patients with end-stage renal disease, a written survey was mailed to the directors of transplantation at all 248 renal transplant centers in the United States. RESULTS All 148 responding centers said they require HIV testing of prospective kidney recipients, and 84% of these centers would not transplant an individual who refuses HIV testing. The vast majority of responding centers would not transplant a kidney from a cadaveric (88%) or a living donor (91%) into an asymptomatic HIV-infected patient who is otherwise a good candidate for transplantation. Among the few centers that would consider transplanting an HIV-infected patient, not a single center had performed such a transplant in the year prior to the survey. Most centers fear that transplantation in the face of HIV infection would be harmful to the individual, and some believe that it would be a waste of precious organs. CONCLUSIONS The great majority of U.S. renal transplant centers will not transplant kidneys to HIV-infected patients with end-stage renal disease, even if their infection is asymptomatic. However, advances in the management of HIV infection and a review of relevant ethical issues suggest that this approach should be reconsidered.
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Affiliation(s)
- A Spital
- University of Rochester School of Medicine, New York, USA.
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Abstract
BACKGROUND Many patients with haemophilia have developed cirrhosis or hepatocellular carcinoma due to transfusion acquired chronic viral hepatitis. AIMS To assess the long term outcome of all haemophilic patients reported to have undergone orthotopic liver transplantation. METHODS Transplant centres of patients identified by medical database search were contacted and survival data assessed by Kaplan-Meier analysis. RESULTS Twenty six haemophilic men (median age 46 years, range 5-63 years) underwent orthotopic liver transplantation in 16 centres between 1982 and 1996. Indications for transplantation were hepatitis C cirrhosis (69%), hepatitis B with or without C cirrhosis (15%), viral hepatitis related hepatocellular carcinoma (12%), and biliary atresia (4%). Six patients (23%) were infected with human immunodeficiency virus (HIV). Postoperatively, the median time to normal clotting factor levels was 24 hours (range 0-48 hours) and exogenous clotting factors were stopped at a median of 24 hours (range 0-480 hours). Four patients (15%) had bleeding complications. The one and three year survival of HIV positive recipients (67% and 23%) was significantly poorer (p = 0.0003) than that of HIV negative recipients (90% and 83%). Coagulopathy was cured in all patients surviving more than 12 days post-transplant. Six of the 20 patients (30%) with hepatitis C cirrhosis pretransplant had evidence of disease recurrence at a mean of nine months post-transplant. CONCLUSIONS Hepatitis C cirrhosis is the most common indication for orthotopic liver transplantation in patients with haemophilia. Transplantation results in long term cure of haemophilia but may be complicated by the effects of HIV infection or recurrent viral hepatitis.
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Affiliation(s)
- F H Gordon
- Department of Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital School of Medicine, London
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Calabrese F, Angelini A, Cecchetto A, Valente M, Livi U, Thiene G. HIV infection in the first heart transplantation in Italy: fatal outcome. Case report. APMIS 1998; 106:470-4. [PMID: 9637269 DOI: 10.1111/j.1699-0463.1998.tb01373.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 46-year-old man with alcoholic dilated cardiomyopathy underwent heart transplantation on November 14, 1985. It was the first cardiac transplant in Italy and at that time no HIV antibody screening test was available in this country. The patient remained in good health for 6 years postoperatively, with only one episode of rejection (type 3A). In June 1992 he died of fulminant complications of AIDS and severe chronic rejection. Neither the patient nor the organ donor belonged to any of the known risk groups for HIV infection; a retrospective analysis revealed that perioperative blood transfusions had been the vectors of transmission.
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Affiliation(s)
- F Calabrese
- Department of Pathology and Cardiovascular Surgery, University of Padua, Italy
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