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English patient received HIV-positive to HIV-positive liver transplant in 2011
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A patient in England received the first known HIV–positive to HIV–positive liver transplant in the world in 2011.
The surgery was performed on July 16, 2011, at the Queen Elizabeth Hospital in Birmingham, England — predating by almost 5 years the first such transplant performed in the United States by a surgical team from Johns Hopkins Medicine.
The English liver recipient, a man aged 47 years, was coinfected with HIV and hepatitis C virus and required a transplantation for primary liver cancer complicating cirrhosis, David Mutimer, MD, professor of clinical hepatology at the University of Birmingham, and colleagues wrote in The New England Journal of Medicine.
The patient had been on ART since 1998 and had an undetectable viral load at the time of transplantation. He opted to accept a liver from an HIV–positive donor after scans showed an increase in his tumor size, threatening to knock him off the list of qualified recipients per U.K. transplant criteria.
The HIV–positive donor, a male with cerebrovascular disease causing brain death, was also seropositive for HCV, but with undetectable serum HCV RNA, which was only confirmed after transplantation.
Donor-derived HIV-1 superinfection in the recipient was successfully managed within 1 week of the transplant without a change in ART regimen. Antivirals were administered for recurrent HCV infection of the graft, according to Mutimer and colleagues.
Their report came months after physicians at Johns Hopkins announced the first HIV–positive to HIV–positive kidney transplant in the U.S. and what was thought to be the first such liver transplant in the world.
“We could have tried to publish this earlier,” Mutimer told Infectious Disease News about the 2011 transplant in England. “However, it is a more complete story now that the hepatitis C infection has been cured.”
Mutimer and colleagues said HIV–positive to HIV–positive liver transplants can be one solution to the shortage of available organs needed in the U.K., and Mutimer said the case proves that excellent outcomes can be achieved with these procedures.
“There will usually be a suitable HIV–positive liver recipient, so transplantation of the liver can be life-saving,” he said. “HIV–positive organ donors are not so common, but every possible means of expanding the organ donor pool should be considered.” – by Gerard Gallagher
Reference:
Hathorn E, et al. N Engl J Med. 2016;doi:10.1056/NEJMc1603850.
Disclosures: Mutimer reports personal fees from Gilead Sciences, AbbVie, Janssen Pharmaceuticals, Merck and Bristol-Myers Squibb outside the submitted work. Please see the full correspondence for a list of all other researchers’ relevant financial disclosures.
Perspective
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Wendy Armstrong, MD
This represents the first reported liver transplant from an HIV-positive patient to an HIV-positive recipient in the world; the second occurred in March at Johns Hopkins University made possible by the HOPE Act in the United States. The patient in this report has nearly five years of follow-up with good outcomes despite receiving an organ from a donor with uncontrolled virus and having clear donor virus viremia in the immediate post-operative period. This is encouraging news for this relatively new endeavor that we hope will increase opportunities for liver transplantation for HIV-infected patients on wait lists around the country.
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