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Orthotopic Liver Transplantation in Human-Immunodeficiency-Virus-Positive Patients in Germany

机译:德国人类免疫缺陷病毒阳性患者的原位肝移植

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摘要

Objectives. This summary evaluates the outcomes of orthotopic liver transplantation (OLT) of HIV-positive patients in Germany. Methods. Retrospective chart analysis of HIV-positive patients, who had been liver-transplanted in Germany between July 1997 and July 2011. Results. 38 transplantations were performed in 32 patients at 9 German transplant centres. The reasons for OLT were end-stage liver disease (ESLD) and/or liver failure due to hepatitis C (HCV) (n = 19), hepatitis B (HBV) (n = 10), multiple viral infections of the liver (n = 2) and Budd-Chiari-Syndrome. In July 2011 19/32 (60%) of the transplanted patients were still alive with a median survival of 61 months (IQR (interquartile range): 41–86 months). 6 patients had died in the early post-transplantation period from septicaemia (n = 4), primary graft dysfunction (n = 1), and intrathoracal hemorrhage (n = 1). Later on 7 patients had died from septicaemia (n = 2), delayed graft failure (n = 2), recurrent HCC (n = 2), and renal failure (n = 1). Recurrent HBV infection was efficiently prevented in 11/12 patients; HCV reinfection occurred in all patients and contributed considerably to the overall mortality. Conclusions. Overall OLT is a feasible approach in HIV-infected patients with acceptable survival rates in Germany. Reinfection with HCV still remains a major clinical challenge in HIV/HCV coinfection after OLT.
机译:目标。本摘要评估了德国HIV阳性患者的原位肝移植(OLT)的结果。方法。 1997年7月至2011年7月在德国进行肝移植的HIV阳性患者的回顾性图表分析。结果。在德国9个移植中心对32例患者进行了38例移植。 OLT的原因是终末期肝病(ESLD)和/或由于丙型肝炎(HCV)(n = 19),乙型肝炎(HBV)(n = 10),肝脏多次病毒感染(n = 2)和Budd-Chiari综合征。 2011年7月,有19/32(60%)的移植患者仍然存活,中位生存期为61个月(IQR(四分位间距):41-86个月)。 6名患者在移植后早期因败血症(n = 4),原发性移植物功能障碍(n = 1)和胸腔内出血(n = 1)死亡。后来有7例患者死于败血病(n = 2),延迟移植失败(n = 2),复发性HCC(n = 2)和肾衰竭(n = 1)。有效预防了11/12例患者再次发生HBV感染; HCV再感染发生在所有患者中,并且对总体死亡率有很大贡献。结论。总体而言,OLT是在德国可以接受的存活率的HIV感染患者的可行方法。 OLT后,HCV再感染仍然是HIV / HCV合并感染的主要临床挑战。

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