Baccarani Umberto, Righi Elda, Adani Gian Luigi, Lorenzin Dario, Pasqualucci Alberto, Bassetti Matteo, Risaliti Andrea
Umberto Baccarani, Gian Luigi Adani, Dario Lorenzin, Andrea Risaliti, Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital of Udine, 33100 Udine, Italy.
World J Gastroenterol. 2014 May 14;20(18):5353-62. doi: 10.3748/wjg.v20.i18.5353.
Before the introduction of combined highly active antiretroviral therapy, a positive human immunodeficiency virus (HIV) serological status represented an absolute contraindication for solid organ transplant (SOT). The advent of highly effective combined antiretroviral therapy in 1996 largely contributed to the increased demand for SOT in HIV-positive individuals due to increased patients' life expectancy associated with the increasing prevalence of end-stage liver disease (ESLD). Nowadays, liver failure represents a frequent cause of mortality in the HIV-infected population mainly due to coinfection with hepatitis viruses sharing the same way of transmission. Thus, liver transplantation (LT) represents a reasonable approach in HIV patients with stable infection and ESLD. Available data presently supports with good evidence the practice of LT in the HIV-positive population. Thus, the issue is no longer "whether it is correct to transplant HIV-infected patients", but "who are the patients who can be safely transplanted" and "when is the best time to perform LT". Indeed, the benefits of LT in HIV-infected patients, especially in terms of mid- and long-term patient and graft survivals, are strictly related to the patients' selection and to the correct timing for transplantation, especially when hepatitis C virus coinfection is present. Aim of this article is to review the pros and cons of LT in the cohort of HIV infected recipients.
在联合高效抗逆转录病毒疗法引入之前，人类免疫缺陷病毒（HIV）血清学状态呈阳性是实体器官移植（SOT）的绝对禁忌证。1996年高效联合抗逆转录病毒疗法的出现，很大程度上促使HIV阳性个体对SOT的需求增加，这是因为随着终末期肝病（ESLD）患病率的上升，患者的预期寿命延长。如今，肝衰竭是HIV感染人群常见的死亡原因，主要是由于与肝炎病毒的共同感染以及相同的传播途径。因此，肝移植（LT）对于感染稳定且患有ESLD的HIV患者来说是一种合理的治疗方法。目前现有的数据有力地支持了在HIV阳性人群中进行LT的做法。所以，问题不再是“对HIV感染患者进行移植是否正确”，而是“哪些患者可以安全地进行移植”以及“何时是进行LT的最佳时机”。事实上，LT对HIV感染患者的益处，尤其是在患者和移植物的中长期存活方面，与患者的选择以及正确的移植时机密切相关，特别是在存在丙型肝炎病毒合并感染的情况下。本文的目的是回顾HIV感染受者队列中LT的利弊。
