Abstract
Management of immunosuppression for human immunodeficiency virus/hepatitis C (HIV/HCV) in living-donor liver transplantation (LDLT) has not been established. We performed LDLT for two patients with HIV/HCV-co-infected end-stage liver disease. The immunosuppression protocol consisted of early calcineurin inhibitor-free and interleukin-2 receptor antagonist (IL2Ra) induction and methylprednisolone. Maintenance low-dose tacrolimus was started and anti-retroviral therapy for HIV was re-started 1 week after LDLT. Consecutively, pegylated interferon and ribavirin therapy were successfully added as pre-emptive therapy for HCV. HIV-RNA and HCV-RNA were undetectable on anti-retroviral therapy and HCV treatment at 17 and 8 months after LDLT, respectively, with normal liver function. This study is the first report of early calcineurin inhibitor-free and IL2Ra induction with methylprednisolone immunosuppression in LDLT for HIV/HCV-co-infected patients with a favorable outcome. Consecutive HIV/HCV treatment was well tolerated.
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References
Koike K, Tsukada K, Yotsuyanagi H, et al. Prevalence of coinfection with human immunodeficiency virus and hepatitis C virus in Japan. Hepatol Res. 2007;37(1):2–5.
Miro JM, Stock P, Teicher E, Duclos-Vallee JC, Terrault N, Rimola A. Outcome and management of HCV/HIV coinfection pre- and post-liver transplantation. A 2015 update. J Hepatol. 2015;62(3):701–11.
Tsukada K, Sugawara Y, Kaneko J, et al. Living donor liver transplantations in HIV- and hepatitis C virus-coinfected hemophiliacs: experience in a single center. Transplantation. 2011;91(11):1261–4.
Velidedeoglu E, Bloom RD, Crawford MD, et al. Early kidney dysfunction post liver transplantation predicts late chronic kidney disease. Transplantation. 2004;77(4):553–6.
Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.
Sugawara Y, Ohkubo T, Makuuchi M, et al. Living-donor liver transplantation in an HIV-positive patient with hemophilia. Transplantation. 2002;74(11):1655–6.
Rana A, Gruessner A, Agopian VG, et al. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150(3):252–9.
de Vera ME, Dvorchik I, Tom K, et al. Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. Am J Transplant. 2006;6(12):2983–93.
Duclos-Vallee JC, Feray C, Sebagh M, et al. Survival and recurrence of hepatitis C after liver transplantation in patients coinfected with human immunodeficiency virus and hepatitis C virus. Hepatology. 2008;47(2):407–17.
Terrault NA, Roland ME, Schiano T, et al. Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection. Liver Transplant. 2012;18(6):716–26.
Goralczyk AD, Hauke N, Bari N, Tsui TY, Lorf T, Obed A. Interleukin 2 receptor antagonists for liver transplant recipients: a systematic review and meta-analysis of controlled studies. Hepatology. 2011;54(2):541–54.
Rafecas A, Rufi G, Figueras J, et al. Liver transplantation without steroid induction in HIV-infected patients. Liver Transplant. 2004;10(10):1320–3.
Tamura S, Sugawara Y, Yamashiki N, Kaneko J, Kokudo N, Makuuchi M. Pre-emptive antiviral therapy in living donor liver transplantation for hepatitis C: observation based on a single-center experience. Transplant Int. 2010;23(6):580–8.
Lawitz E, Sulkowski MS, Ghalib R, et al. Simeprevir plus sofosbuvir, with or without ribavirin, to treat chronic infection with hepatitis C virus genotype 1 in non-responders to pegylated interferon and ribavirin and treatment-naive patients: the COSMOS randomised study. Lancet. 2014;384(9956):1756–65.
Sulkowski MS. Drug-induced liver injury associated with antiretroviral therapy that includes HIV-1 protease inhibitors. Clin Infect Dis. 2004;38(Suppl 2):S90–7.
Sulkowski MS, Mehta SH, Chaisson RE, Thomas DL, Moore RD. Hepatotoxicity associated with protease inhibitor-based antiretroviral regimens with or without concurrent ritonavir. AIDS. 2004;18(17):2277–84.
Acknowledgments
The authors were supported by a Grant-in-Aid for Research on HIV/AIDS from the Ministry of Health, Labor, and Welfare of Japan, the “Eguchi project” and Grants 26462039 (Kaneko) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.
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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Maki, H., Kaneko, J., Akamatsu, N. et al. Interleukin-2 receptor antagonist immunosuppression and consecutive viral management in living-donor liver transplantation for human immunodeficiency virus/hepatitis C-co-infected patients: a report of 2 cases. Clin J Gastroenterol 9, 32–37 (2016). https://doi.org/10.1007/s12328-015-0621-8
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DOI: https://doi.org/10.1007/s12328-015-0621-8