Living donor liver transplantations in HIV- and hepatitis C virus-coinfected hemophiliacs: experience in a single center

• Published in: Transplantation Vol. 91; no. 11; p. 1261
• Main Authors: Tsukada, Kunihisa, Sugawara, Yasuhiko, Kaneko, Junichi, Tamura, Sumihito, Tachikawa, Natsuo, Morisawa, Yuji, Okugawa, Shu, Kikuchi, Yoshimi, Oka, Shinichi, Kimura, Satoshi, Yatomi, Yutaka, Makuuchi, Masatoshi, Kokudo, Norihiro, Koike, Kazuhiko
• Format: Journal Article
• Language: English
• Published: United States 15.06.2011
• Subjects: Adult; Blood Coagulation; CD4 Lymphocyte Count; Hemophilia A - complications; Hepatitis C - complications; Hepatitis C - drug therapy; HIV Infections - complications; Humans; Immunosuppression; Liver Transplantation - mortality; Living Donors; Male; Survival Rate
• ISSN: 1534-6080
• DOI: 10.1097/tp.0b013e3182193cf3

Although almost all human immunodeficiency virus (HIV)-infected Japanese hemophiliacs are coinfected with hepatitis C virus (HCV), the outcome of living donor liver transplantation (LDLT) in such patients in terms of survival rate, perioperative complications, and recovery of coagulation activity is poorly understood. Six HIV-positive hemophiliacs underwent LDLT for HCV-associated advanced cirrhosis. The mean CD4 T-cell count at transplantation was 376±227/μL. The 1-, 3-, and 5-year survival rates were 66%, 66%, and 50%, respectively. Fatal perioperative bleeding related to hemophilia was not observed. Two patients died within 6 months after transplantation due to graft failure. HIV infection was well controlled in all patients who survived longer than 6 months. Two patients (genotype 2a and 2+3a) achieved a sustained viral response and both of them were alive at the end of follow-up period, whereas one patient (genotype 1a+1b) died of decompensated cirrhosis 4 years after transplantation due to recurrent HCV infection. HIV/HCV-coinfected hemophiliacs can safely undergo LDLT. Hemophilia was clinically cured after successful transplantation. A good outcome can be expected as long as postoperative hepatitis C is controlled with interferon/ribavirin combination therapy.