Orthotopic Liver Transplantation in Human-Immunodeficiency-Virus-Positive Patients in Germany

Abstract

Objectives. This summary evaluates the outcomes of orthotopic liver transplantation (OLT) of HIV-positive patients in Germany. Methods. Retrospective chart analysis of HIV-positive patients, who had been liver-transplanted in Germany between July 1997 and July 2011. Results. 38 transplantations were performed in 32 patients at 9 German transplant centres. The reasons for OLT were end-stage liver disease (ESLD) and/or liver failure due to hepatitis C (HCV) (𝑛=19), hepatitis B (HBV) (𝑛=10), multiple viral infections of the liver (𝑛=2) and Budd-Chiari-Syndrome. In July 2011 19/32 (60%) of the transplanted patients were still alive with a median survival of 61 months (IQR (interquartile range): 41–86 months). 6 patients had died in the early post-transplantation period from septicaemia (𝑛=4), primary graft dysfunction (𝑛=1), and intrathoracal hemorrhage (𝑛=1). Later on 7 patients had died from septicaemia (𝑛=2), delayed graft failure (𝑛=2), recurrent HCC (𝑛=2), and renal failure (𝑛=1). Recurrent HBV infection was efficiently prevented in 11/12 patients; HCV reinfection occurred in all patients and contributed considerably to the overall mortality. Conclusions. Overall OLT is a feasible approach in HIV-infected patients with acceptable survival rates in Germany. Reinfection with HCV still remains a major clinical challenge in HIV/HCV coinfection after OLT.