Diagnostic dilemma of coagulation problems in an HIV-positive patient with end-stage liver disease undergoing liver transplantation

Abstract

Human immunodeficiency virus (HIV) may result in devastating multi-organ complications, including cirrhosis. Consequently, liver transplantation is often required for these patients. We report a case of a 43-year-old female with cryptogenic cirrhosis and HIV on highly active antiretroviral therapy, presenting for non-related living donor liver transplantation. The intra-operative course was complicated by hepatic artery and portal vein thrombosis, requiring thrombectomy. On postoperative day-3, the patient required re-transplantation with a cadaveric donor organ due to primary graft failure.

Keywords: Hypercoagulation; Liver transplant; Highly active antiretroviral therapy; Human immunodeficiency virus

Core tip: Liver transplantation is a technically complicated procedure associated with both predictable and unpredictable coagulation abnormalities. The surgeons are more concerned about bleeding than thrombotic complications in cirrhotic patients undergoing liver transplant, but the reality these patients are equally at risk of both complications. The risk of a thrombotic event is even higher in human immunodeficiency virus (HIV) patients on highly active antiretroviral therapy (HAART) both during and after the surgical procedure. This fact should be ranked high in the differential diagnosis of liver allograft failure in liver transplant recipients who are HIV positive and receiving HAART.