Liver transplantation in patients with HIV infection

Liver transplantation in HIV-positive patients: the position of the Brazilian groups

“…Indeed, the publication of the largest series evaluating the results of the procedure in patients with HIV infection using HAART are recent, the number of cases included is small, and the follow-up time is short (10,21,22,29) . For example, a multicenter study involving major transplanting centers (Pittsburgh, Miami, San Francisco, Minneapolis and London), published in 2003, evaluated 24 patients, with mean follow-up of 17 months (27) .…”

“…In these, the mean follow-up was 18 months and the 1 year survival rate was 76% (considering all patients). In those who did not progress to death in the first 30 days (26 patients), 1 year survival was 89% (10) . In the experience of RAGNI et al (27) with 24 HIV-positive, the cumulative survival rate in 1, 2 and 3 years was 87.1%, 72.8% and 72.8%, respectively, while in HIV-negative patients it was 86.6%, 81.6% and 77.9%.…”

“…Thus, at present this history does not seem to be a good predictor of survival, as long as the patient is stable, considering the CD4 count and the viral load. However, patients with opportunistic infection in the preceding 6-12 months have not been submitted to transplantation (10) .…”

“…Most of the Brazilian groups reported adopting these parameters, more often including patients with undetectable viral load and CD4 count above 250/ mm 3 , considering the count of the 6 months preceding inclusion in the list. Since cirrhotic patients with hypersplenism may have a low CD4 count, this may not reflect the clinical state of the patient, and thus the absolute count of neutrophils should be taken into consideration (10) . The criteria of exclusion have been changed as the groups gain more experience.…”

“…Recent studies showed that, Brandão ABM, Mariante-Neto G. Liver transplantation in HIV-positive patients: the position of the Brazilian groups in selected individuals, the results of liver transplantation are good, and, most importantly, there is no evidence that the HIV infection is accelerated (10,21,29) . In Brazil, the Ministry of Health does not contraindicate or prohibit liver transplantation in these patients (4) .…”