Case study describes first successful liver transplant from living donor with HIV and prior HCV

A person living with virally suppressed HIV who has been cured of hepatitis C (HCV) could be a successful living donor for someone needing a liver transplant, a groundbreaking case study out of Italy suggests.

About This Study

“Successful living donor liver transplantation from an HIV and HCV positive donor: report from the first case in the world” was published online on March 6, 2023, in AIDS. The lead author is Stefano Di Sandro, M.D., Ph.D., of the Hepato-pancreato-biliary Surgery and Liver Transplantation Unit at the University of Modena and Reggio Emilia in Modena, Italy.

Key Research Findings

This single-case study manuscript describes the first living donor liver transplantation from an HIV- and HCV-positive donor reported in the world. Previously, a living donor liver transplant had been performed in South Africa from a mother living with HIV to her HIV-negative child, the study authors stated. In addition, they noted that livers from deceased donors who had been living with HIV/HCV have been previously transplanted—but that this marked the first time such a transplant has been performed from a living donor.

The 60-year-old male recipient was living with HIV and had previously been diagnosed with hepatitis B, C, and D. He had a history of intravenous drug use, but no alcohol abuse. After treatment, HIV and hepatitis were well controlled. However, his liver was so severely damaged that he was admitted twice to the hospital for hepatic failure. As a result, he was listed for a transplant, but given a low priority.

The recipient’s 52-year-old wife volunteered as a donor, but was living with HIV and HCV, both likely contracted from her husband. Once direct acting antivirals became available, her HCV had been successfully treated, and her HIV was well controlled. Before the transplant, her liver function values were normal, and no fibrosis nor significant liver steatosis were detected.

No complications ensued after the transplant. The wife and husband were discharged from the hospital three and six days after the surgery, respectively, and no problems were detected, with both doing well one year later.

Discussion Highlights and Implications for Practice

The treating physicians considered the HIV/HCV coinfection not to pose an undue risk to the donor since both viruses were under control, there was no evidence of HIV or HCV replication, and no signs of chronic hepatitis.

The authors emphasized that the success of this case shows that a virally suppressed person living with HIV and sustained virologic response after HCV treatment should not be excluded as a potential living donor just because of these viruses.

By Barbara Jungwirth