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Liver Transplants: What You Need to Know

August 2003

The decision to treat HCV, when to treat and how to manage side effects of treatment, can be difficult. While treating HCV isn't a picnic, end-stage liver disease has far worse side effects and consequences. The only treatment for end-stage liver disease or liver failure is liver transplantation.

Up until recently, hospitals would not perform organ transplants on people living with HIV. Over the past few years, with activist pressure, programs to provide organ transplants to people with HIV have been springing up around the country. The procedure is considered experimental, often difficult to get public or private insurance coverage for and the process for qualifying for an organ transplant is rigid.

Long-term management of a liver transplant requires taking daily, life-long, immune suppressive drugs to prevent rejecting the new liver. These drugs interact with many anti-HIV drugs and must be checked carefully. It's key that blood levels of anti-rejection drugs remain constant. Missing doses of or stopping anti-HIV drugs without the careful support of both an HIV and liver transplant team specialist can alter the blood levels of the anti-rejection medications, which can have serious life-threatening consequences.

While liver transplantation provides an option and can save lives, it's certainly not the best, easiest or most optimal way to approach HCV treatment. Unlike treatment for HCV, where support networks are desirable, in the case of transplantation these types of networks and support are fundamentally required. The life-time cost of a liver transplant far exceeds those for HCV treatment. The challenges of long-term, life-time use of immune suppressive anti-rejection medications can be far more complicated than HCV treatment. Preventing HCV from progressing to end-stage liver disease and liver failure is far easier, even when considering the difficulty and challenges of HCV treatment. Also, a liver transplant doesn't remove HCV from the body and the virus can infect the liver and again begin the cycle of HCV-related complications -- perhaps leading to the need for another transplant.

When weighing the pros and cons and factoring in the challenge of HCV treatment, the alternative to treating if HCV disease should progress to end-stage liver disease/liver failure needs to be taken into consideration. Liver transplantation can save lives and remains an option, but it's by no means a desirable first option.

For more information on sites that perform liver transplantation in people living with HIV, call Project Inform's Hotline or visit The Emmes Corporation website at The website provides details and contact information for centers participating in the liver transplant project for people living with HIV as well as information of other centers willing to transplant people living with HIV.

In Order to Qualify for a Transplant ...

There are slight variations in eligibility criteria among transplant centers. In general, in order to qualify for a liver transplant, people need to have very advanced liver disease and:

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