39th National Congress of the Italian Society of Organ TransplantationGeneral observationSolid Organ Transplantation in HIV+ Recipients: Italian Experience

•Recent studies indicate that human immunodeficiency virus (HIV) infection need no longer be considered a contraindication to liver transplantation. This is largely the result of successful suppression of HIV replication with combination antiretroviral medication. Although an HIV-infected patient has not received a transplant in British Columbia yet, this may change. Reports from the United States, Europe, and Japan suggest that liver transplantation has become a viable option for people living with HIV/AIDS.•Considering HIV as an absolute contraindication to transplantation is a historical artifact, not a practice based on current medical evidence. When it comes to ethical concerns, HIV is now considered on a par with other chronic illnesses, such as hepatitis C monoinfection, diabetes, or hemophilia.•Viral co-infection with either hepatitis B or hepatitis C has become a leading cause of morbidity and mortality among people living with HIV. HIV and hepatitis C virus co-infection is an important problem in British Columbia. Up to 90% of HIV-infected injection drug users are HCV-positive, and over 40% of individuals receiving antiretroviral drugs who have been tested for hepatitis C in the province are coinfected. Already, hepatitis C is an independent predictor of mortality among HIV-positive individuals receiving antiretroviral treatment in British Columbia. The prevalence of chronic hepatitis B infection among HIV-infected individuals in North America is estimated at 9% and is also an important source of morbidity among HIV-infected persons. Therefore, although the prognosis for HIV-infected patients has improved remarkably over the past several years, it is the presence of coexisting morbidities, including end-stage liver disease secondary to viral hepatitis, that is now having the greatest impact on survival.•In Italy in recent years, an increase in transplantations in HIV-positive recipients has been observed. In the future, the decision to perform “positive to positive” transplantations is a real option.

IntroductionAccording to current estimates, there are about 540,000 patients who are infected with HIV in Western Europe, of which about 3100 are potential candidates for organ transplantation. In Italy, there are currently 85 HIV patients on the transplant list.MethodsOrgan transplantation activity in HIV recipients from 2002 to December 2014 was assessed from the database provided by the Transplant Center of Modena until the year 2011. For the years 2012 to 2014, data are from the Transplant Information System (SIT). The follow-up data have been extracted from the function “Quality” of the SIT.ResultsThe transplant centers on Italian territory that meet the requirements according to national protocol are in total 29: 11 for the liver, 9 for the kidney including 1 pediatric, 3 for the heart, 3 for the lungs, and for 3 for the combined kidney-pancreas. Since 2002, 257 organ transplantations were carried out, including 185 liver, 59 kidney, 5 combined liver-kidney, 5 combined kidney-pancreas, 2 heart, and 1 double lung. The first cause of death is represented by co-hepatitis C virus infection, in particular in 26 liver recipients (37%) and in 3 kidney recipients (20%).ConclusionsThe analysis showed that transplantation activity in HIV is on the rise, especially in the last 2 years, with an outcome similar to that reported in the literature.