Outcomes of ABO-incompatible liver transplantation in end-stage liver disease patients co-infected with hepatitis B and human immunodeficiency virus

Abstract

Background: Human immunodeficiency virus (HIV)-positive patients coinfected with hepatitis B virus (HBV) are eligible for liver transplantation (LT) in Africa and Southeast Asia, particularly China. However, the outcome of HIV-HBV coinfected patients referred for ABO-incompatible LT (ABOi-LT) is unknown.

Aim: To clarify the outcome of ABOi-LT for HIV-HBV coinfected patients with end-stage liver disease (ESLD).

Methods: We report on two Chinese HIV-HBV coinfected patients with ESLD who underwent A to O brain-dead donor LT and reviewed the literature on HIV-HBV coinfected patients treated with ABO-compatible LT. The pretransplantation HIV viral load was undetectable, with no active opportunistic infections. Induction therapy consisted of two sessions of plasmapheresis and a single dose of rituximab in two split doses, followed by an intraoperative regimen of intravenous immunoglobulin, methylprednisolone, and basiliximab. Post-transplant maintenance immunosuppressive agents consisted of tacrolimus and mycophenolate mofetil, and prednisone.

Results: At the intermediate-term follow-up, patients showed undetectable HIV viral load, CD4(+) T cell counts greater than 150 cells/μL, no HBV recurrence, and stable liver function. A liver allograft biopsy showed no evidence of acute cellular rejection. Both patients survived at 36-42 mo of follow-up.

Conclusion: This is the first report of ABOi-LT in HIV-HBV recipients with good intermediate-term outcomes, suggesting that ABOi-LT may be feasible and safe for HIV-HBV coinfected patients with ESLD.

Keywords: ABO incompatibility liver transplantation; End-stage liver disease; Hepatitis B virus; Human immunodeficiency virus; Immunosuppression.

Figure 1

Dynamic changes in immunological indicators and liver function in case 1. A: Trends of anti-A immunoglobulin M (IgM)/immunoglobulin G (IgG) titers and CD4(+) T cell counts over time; B: Trends of liver enzymes over time after liver transplantation. γGT: γ-glutamyltransferase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Tbil: Total bilirubin.

Figure 2

Pathological results of liver allograft biopsy. A: Patient 1. The pathology results of liver allograft biopsy showed mild portal inflammation, mild venous endothelial inflammation, mild small bile duct inflammation and capillary bile duct cholestasis suggesting mild acute cellular rejection (Banff rejection activity index score, 4); B: Patient 2. The pathology results suggested chronic interlobular cholangitis with bile duct sclerosis and the possibility of early chronic rejection.

Figure 3

Dynamic changes in immunological indicators and liver function of case 2. A: Trends of anti-A immunoglobulin M (IgM)/immunoglobulin G (IgG) titers and CD4(+) T cell counts over time; B: Trends of liver enzymes over time after liver transplantation. γGT: γ-glutamyltransferase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Tbil: Total bilirubin.