Is liver transplantation an option for HIV-infected persons?
Liver transplantation is an option in some transplant centers that combine expertise in HIV management with the transplant service. In a study at 5 institutions of 24 HIV-infected patients survival rates were similar to rates in patients without HIV infection (Ragni et al, 2003). Nevertheless, management is complicated by problems of drug interactions between ART and the standard immunosuppressive agents, poor tolerance of ART after liver transplantation, and relatively high frequency of acute graft rejection. As in patients without HIV infection, the prognosis with liver transplantion is poorer when liver disease is caused by HCV. The recommendation at present is to give the highest priority in patients with HIV infection to those without HCV and to those receiving and tolerating ART who have achieved HIV virologic control and immune reconstitution.
