icon_folder.gif   Conference Reports for NATAP  
 
  ICAAC 41st Interscience Conference on Antimicrobial Agents and Chemotherapy
 
Chicago, Illinois, December 16-19
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Abstract: I-203. Solid Organ Transplantation in Patients with Human Immunodeficiency Syndrome: a Successful Case Series.
 
 
  G.T. NEFF, D. JAYAWEERA, O. HUNG, D. LEVI, D. WEPPLER, J. NERRY, T. KATO, L. DOWDY, C. OBRIAN, K. REDDY, L. KRAVETZ, E. SCHIFF, A. TZAKIS
 
University of Miami, Miami, FL
 
Introduction: We report the results of a series of patients with human immunodeficiency syndrome (HIV) co-infected with Hepatitis B (HBV) and/or C (HCV) and decompensated cirrhosis receiving orthotopic liver transplantation (OLT).
 
Methods: Six patients with HIV with decompensated cirrhosis secondary to HBV and/or HBV were listed for OLT based on UNOS criteria. All patients were reviewed and treated by the University of Miami HIV team. Highly active antiretroviral therapy (HAART) regimen was initiated prior to OLT in 5/6 patients. One patient presented with fulminant hepatitis and we were unable to initiate the HAART regimen prior to OLT. Patients are followed by a team of transplant surgeons/hepatology/HIV team.
 
Results: The patients demographics include: 5 men and 1 women, mean age 49 years (43-52Y), 4/6 with HBV, 3/6 patients with HCV (the poster reported 1/6 had HCV but I spoke with Neff and he said that was a misprint as 3 patients had HCV; after we spoke, he changed the poster by pen), 1/6 patients with both HCV and HBV. All but one had an HIV viral load (HIV-VL) < 50 copies/cc3 RNA PCR, and CD4 count >100 cells/mm3 prior to OLT. Five patients successfully received OLT. One patient succumbed to sepsis while awaiting OLT. The 5 patients that received OLT have to date survival period of 5, 6, 7, 12, 24 months (mean 10.8). One patient suffered acute rejection and another wound infection but both recovered. Two patients experienced tacrolimus toxicity due to drug interaction with the protease inhibitors. All patients are on a HAART therapy and remained with a CD 4 count >100 cells/mm3. All but one had the HIV-VL undetectable. Patient with HIV rebound is now responding to treatment. None on the 5 patients have experienced an opportunistic infection post OLT. Neff told me 2/3 with HCV were doing well about 1.5 years after transplant but the other patient was not doing well.
 
Conclusion: Although, these results are preliminary, they suggest that patients infected with HIV suffering from decompensated cirrhosis associated with HBV and/or HCV co-infection, may be suitable candidates for OLT.
 
Note from Jules Levin: Neff told me he has a number of patients on their waiting list. A number of small preliminary studies show that HCV/HIV coinfected patients appear to be good transplant candidates and respond as well as non-HIV infected patients with HCV. Reimbursers are generally not reimbursing for liver transplants in HCv/HIV coinfected patients as they consider the treatment too experimental.