Objectives: Liver disease is one of the most frequent causes of non AIDS related deaths in HIV patients and transplantation has become a therapeutic option. In spite of this progress, no liver transplantation has ever been recorded for the patients of the Brussels Saint-Pierre HIV Cohort. The aim of this study is to identify the barriers to liver transplantation in HIV patients that arise in our practice.
Methods: All patients enrolled in the Brussels Saint-Pierre HIV Cohort presenting a theoretical indication for liver transplantation, as recommended by the AASLD, between 01/01/2002 and 01/07/2010 were considered. The reasons for not retaining these patients as candidates for liver transplantation were classified as HIV or non-HIV related.
Results: Nineteen patients were identified. All patients presented an HBV and/or HCV co-infection. Indication for liver transplantation was based on first severe complication of cirrhosis for 15 patients, hepatocellular carcinoma fulfilling the Milan criteria for 2 and chronic liver failure for 2 others. Three patients could have been transplantation candidates but only one was enlisted and died prior to transplantation whilst alternative treatments were chosen for the remaining two. Among the non candidates, 5 couldn't be enlisted for HIV-related reasons, 3 for non HIV related reasons and 8 on multifactorial grounds; non adherence to treatment, alcohol abuse, psychiatric disease and hepatotoxicities playing key roles. Eleven patients died, all within 12 months of their first major complication of cirrhosis.
Conclusions: The undeniable medical progress that liver transplantation represents for HIV-infected individuals is, in practise, limited; only a minority of patients with an indication of liver transplant will fulfill the necessary criteria for enlistment. General awareness of this issue and early referral are essential to optimize pre-transplant management and increase the number of HIV patients developing ESLD that will be able to benefit from this cure.