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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2015; 21(43): 12311-12321
Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12311
Role of liver transplantation in human immunodeficiency virus positive patients
Deepak Joshi, Kosh Agarwal
Deepak Joshi, Kosh Agarwal, Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS London, United Kingdom
Author contributions: Joshi D and Agarwal K reviewed the literature and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Deepak Joshi, Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS London, United Kingdom.
Telephone: +44-203-2999000
Received: April 24, 2015
Peer-review started: April 24, 2015
First decision: August 2, 2015
Revised: August 4, 2015
Accepted: October 23, 2015
Article in press: October 26, 2015
Published online: November 21, 2015

End-stage liver disease (ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus (HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus (HCV) infection, drug-induced hepatotoxicity related to combined anti-retro-viral therapy, alcohol related liver disease and non-alcohol related fatty liver disease appear to be the leading causes. It is therefore, anticipated that more HIV-positive patients with ESLD will present as potential transplant candidates. HIV infection is no longer a contraindication to liver transplantation. Key transplantation outcomes such as rejection and infection rates as well as medium term graft and patient survival match those seen in the non-HIV infected patients in the absence of co-existing HCV infection. HIV disease does not seem to be negatively impacted by transplantation. However, HIV-HCV co-infection transplant outcomes remain suboptimal due to recurrence. In this article, we review the key challenges faced by this patient cohort in the pre- and post-transplant period.

Keywords: Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus, Liver transplantation

Core tip: Liver disease is a major cause of mortality and morbidity in human immunodeficiency virus (HIV) positive patients. It is therefore increasingly likely that HIV positive patients with chronic liver disease are likely to present as potential liver transplant candidates. We therefore review the current data with regards to liver transplantation in HIV positive patients.