Living Donor Liver Transplantations in HIV- and Hepatitis C Virus-Coinfected Hemophiliacs: Experience in a Single Center

Background. Although almost all human immunodeficiency virus (HIV)-infected Japanese hemophiliacs are coinfected with hepatitis C virus (HCV), the outcome of living donor liver transplantation (LDLT) in such patients in terms of survival rate, perioperative complications, and recovery of coagulation activity is poorly understood. Patients and Methods. Six HIV-positive hemophiliacs underwent LDLT for HCV-associated advanced cirrhosis. The mean CD4 T-cell count at transplantation was 376±227/&mgr;L. Results. The 1-, 3-, and 5-year survival rates were 66%, 66%, and 50%, respectively. Fatal perioperative bleeding related to hemophilia was not observed. Two patients died within 6 months after transplantation due to graft failure. HIV infection was well controlled in all patients who survived longer than 6 months. Two patients (genotype 2a and 2+3a) achieved a sustained viral response and both of them were alive at the end of follow-up period, whereas one patient (genotype 1a+1b) died of decompensated cirrhosis 4 years after transplantation due to recurrent HCV infection. Conclusions. HIV/HCV-coinfected hemophiliacs can safely undergo LDLT. Hemophilia was clinically cured after successful transplantation. A good outcome can be expected as long as postoperative hepatitis C is controlled with interferon/ribavirin combination therapy.

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