Indications and waiting list priority for deceased donor liver transplantation in HIV/HCV co‐infected hemophilic patients in Japan through contaminated blood product

Abstract

HIV/HCV co‐infection from blood products for hemophilia has been a social problem in Japan. Liver transplantation (LT) is an important treatment option for hepatic failure and cirrhosis of the liver in co‐infected patients, and appropriate indications for LT, especially organ form deceased donors, are required by society. The aim is to propose priority status for the waiting list for deceased donor (DD) LT in HIV/HCV co‐infected patients in Japan based on medical and scientific considerations. Since 2009, we have been working on the subject in research projects under grants‐in‐aid for health and labour sciences research on AIDS measures provided by the Ministry of Health, Labour and Welfare (the Kanematsu project and Eguchi project). Our research showed that hepatic fibrosis is advanced in HIV/HCV co‐infected Japanese patients, especially those with hemophilia who became infected from blood products at a faster rate than HCV mono‐infected patients. In addition, those patients who developed portal hypertension had a poor prognosis at a young age. The results of our research contributed to increasing the priority score of those patients on the deceased donor liver transplantation (DDLT) waiting list in 2013 and to establishing a scoring system for DDLT corresponding to the Model for End‐stage Liver disease (MELD) score in 2019. This paper introduces changes in priority and the current state of priority of the DDLT waiting list for HIV/HCV co‐infected patients in Japan.

National survey of hepatobiliary and pancreatic surgery in hemophilia patients in Japan

“…In the early 1980s, unheated contaminated blood products for hemophilia caused a crisis of HIV/HCV coinfection in Japan. After the introduction of antiretroviral therapy (ART) for HIV in the mid‐1990s, acquired immunodeficiency syndrome (AIDS) was superseded by HCV‐related liver disease as the main cause of death in hemophilia patients 2 . HCC is well recognized as a fatal complication of HCV cirrhosis, and its treatment has been standardized both in Western countries 8 and in Japan 9 .…”

“…After the introduction of antiretroviral therapy (ART) for HIV in the mid-1990s, acquired immunodeficiency syndrome (AIDS) was superseded by HCV-related liver disease as the main cause of death in hemophilia patients. 2 HCC is well recognized as a fatal complication of HCV cirrhosis, and its treatment has been standardized both in Western countries 8 and in Japan. 9 However, because of the bleeding tendency of hemophiliac patients, physicians might hesitate to perform surgical resection of the liver or even ultrasound-guided radio frequency ablation (RFA), 10 despite those treatments being indicated.…”

“…Especially in the 1980s, most hemophiliacs were coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) by blood products, and although treatment for AIDS was established, liver carcinogenesis and liver failure due to HCV and previous usage of hepatotoxic anti‐HIV drugs became a problem. As a research project of Ministry of health (MOH), we have continued research on the indications and results of liver transplantation for patients coinfected with HIV/HCV from blood products 2‐4 . However, there are no comprehensive reports on surgical operations other than liver transplantation in patients with hemophilia, and, in particular, research studies on hepatobiliary and pancreatic surgery (HBPS) have not been conducted.…”

“…As a research project of Ministry of health (MOH), we have continued research on the indications and results of liver transplantation for patients coinfected with HIV/HCV from blood products. [2][3][4] However, there are no comprehensive reports on surgical operations other than liver transplantation in patients with hemophilia, and, in particular, research studies on hepatobiliary and pancreatic surgery (HBPS) have not been conducted. According to international reports, hepatocellular carcinoma (HCC) in patients with HIV infection showed distinct characteristics: (a) many young cases, (b) many diffuse / infiltrative types, and (c) results of liver transplantation equivalent to those of HIV-negative cases.…”

Impact of sustained viral response for hepatitis C virus on the outcomes of liver transplantation in hemophilic patients with human immunodeficiency virus/hepatitis C virus co‐infection: A nationwide survey in Japan

“…In Japan, our study group advocated changes in the current order of priority for the deceased donor LT (DDLT) waiting list for patients co-infected with HIV/HCV, including an increase in priority for co-infected patients in 2013 and the establishment of a scoring system for DDLT registration corresponding to the Model for End-stage Liver Disease (MELD) in 2019. 14 Recently, the introduction of the use of the direct-acting antiviral agent (DAA) for HCV has been shown to eradicate HCV hepatitis and related liver cirrhosis, even in patients with HIV [15][16][17] after LT for HCV-related liver cirrhosis. Previously, our LT patients were reinfected with HCV and became cirrhotic within 5 years; however, after the introduction of DAA, our patients attained a better overall survival after LT.…”