Current status of liver transplantation for human immunodeficiency virus-infected patients in mainland China

Abstract

According to the report from the Chinese Center for Disease Control and Prevention, the prevalence of human immunodeficiency virus (HIV) infection exceeded 1.2 million individuals by the year 2022, with an annual increase of about 80000 cases. The overall prevalence of hepatitis B surface antigen among individuals co-infected with HIV reached 13.7%, almost twice the rate of the general population in China. In addition to the well-documented susceptibility to opportunistic infections and new malignancies, HIV infected patients frequently experience liver-related organ damage, with the liver and kidneys being the most commonly affected. This often leads to the development of end-stage liver and kidney diseases. Therefore, organ transplantation has emerged as an important part of active treatment for HIV infected patients. However, the curative effect is not satisfactory. HIV infection has been considered a contraindication for organ transplantation. Until the emergence of highly active anti-retroviral therapy in 1996, the once intractable replication of retrovirus was effectively inhibited. With prolonged survival, the failure of important organs has become the main cause of death among HIV patients. Therefore, transplant centers worldwide have resumed exploration of organ transplantation for HIV-infected individuals and reached a positive conclusion. This study provides an overview of the current landscape of HIV-positive patients receiving liver transplantation (LT) in mainland China. To date, our transplant center has conducted LT for eight end-stage liver disease patients co-infected with HIV, and all but one, who died two months postoperatively due to sepsis and progressive multi-organ failure, have survived. Comparative analysis with hepatitis B virus-infected patients during the same period revealed no statistically significant differences in acute rejection reactions, cytomegalovirus infection, bacteremia, pulmonary infections, acute kidney injury, new-onset cancers, or vascular and biliary complications.

Keywords: Liver transplantation; Human immunodeficiency virus; Infection; Hepatitis B virus; End-stage liver disease; Mainland China

Core Tip: In mainland China, human immunodeficiency virus (HIV) infection has long been considered an absolute contraindication for liver transplantation (LT). Until June 2004, Chinese scholars performed LT on two HIV patients, but these cases were only followed up for 24 and 22 months, respectively. Subsequently, there were no reported cases of LT in mainland China for patients with HIV infection until April 2019, when our transplant center performed ABO-incompatible LT for a patient with liver failure co-infected with HIV and hepatitis B virus. This study provides an overview of the current landscape of HIV-positive patients receiving liver transplantation in mainland China.