Topic Highlight
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 14, 2014; 20(18): 5353-5362
Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5353
Pros and cons of liver transplantation in human immunodeficiency virus infected recipients
Umberto Baccarani, Elda Righi, Gian Luigi Adani, Dario Lorenzin, Alberto Pasqualucci, Matteo Bassetti, Andrea Risaliti
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy
Elda Righi, Matteo Bassetti, Division of Infectious Disease, University Hospital of Udine, 33100 Udine, Italy
Alberto Pasqualucci, Department of Anaesthesiology, University of Perugia, 33100 Udine, Italy
Author contributions: Baccarani U and Righi E equally contributed to conception and design, acquisition of data, or analysis and interpretation of data, drafted and revised the article critically for important intellectual content; Adani GL and Lorenzin D made substantial contributions to acquisition of data or analysis and interpretation; Pasqualucci A, Bassetti M and Risaliti A made final approval of the version to be published.
Correspondence to: Umberto Baccarani, MD, PhD, FEBS, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, P.le S.M. della Misericordia 15, Pad. Petracco, 33100 Udine, Italy. umberto.baccarani@uniud.it
Telephone: +39-432-559902 Fax: +39-432-559552
Received: October 21, 2013
Revised: December 5, 2013
Accepted: January 19, 2014
Published online: May 14, 2014
Abstract

Before the introduction of combined highly active antiretroviral therapy, a positive human immunodeficiency virus (HIV) serological status represented an absolute contraindication for solid organ transplant (SOT). The advent of highly effective combined antiretroviral therapy in 1996 largely contributed to the increased demand for SOT in HIV-positive individuals due to increased patients’ life expectancy associated with the increasing prevalence of end-stage liver disease (ESLD). Nowadays, liver failure represents a frequent cause of mortality in the HIV-infected population mainly due to coinfection with hepatitis viruses sharing the same way of transmission. Thus, liver transplantation (LT) represents a reasonable approach in HIV patients with stable infection and ESLD. Available data presently supports with good evidence the practice of LT in the HIV-positive population. Thus, the issue is no longer “whether it is correct to transplant HIV-infected patients”, but “who are the patients who can be safely transplanted” and “when is the best time to perform LT”. Indeed, the benefits of LT in HIV-infected patients, especially in terms of mid- and long-term patient and graft survivals, are strictly related to the patients’ selection and to the correct timing for transplantation, especially when hepatitis C virus coinfection is present. Aim of this article is to review the pros and cons of LT in the cohort of HIV infected recipients.

Keywords: Liver transplantation, Human immunodeficiency virus/hepatitis C virus coinfection, Hepatocellular carcinoma, Immunosuppression

Core tip: This article reviews the most recent literature in the field of liver transplantation in human immunodeficiency virus (HIV) positive recipients with special focus on hepatitis C virus/HIV coinfection and hepatocellular carcinoma in HIV recipients. This field of research is one of the most intriguing up to now since end-stage liver disease has become the first cause of death in HIV patients and the request for liver transplantation in this subgroup of HIV positive patients is going to increase over time.