Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12311
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.
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.