Liver Transplants: What You Need to Know
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 www.emmes.com. 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.
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:
CD4+ cell counts above 100 for six months prior to transplantation with no history of active serious life-threatening -- OR -- if a history (not current) of study-allowed active serious infections and/or cancers, then CD4+ cell counts must be above 200.
HIV Levels must be optimally controlled (undetectable) by anti-HIV drugs for at least three months prior to transplantation -- OR -- it must be deemed by HIV experts that an effective anti-HIV regimen is available that is highly likely to control HIV post-transplant.
Payment -- A commitment to pay by insurance or other third-party payer coverage is required.
Stable Living Situation -- People need to show that they have a stable living situation with the support of family and/or friends to help in post-transplant recovery.
Alcohol/Drug Use -- Current alcohol or illicit drug use is not allowed and it may be required that transplant candidates participate in a successful alcohol/drug recovery program for at least six months with a long-term commitment to continued sobriety.
Commitment to using anti-HIV medications, anti-rejection drugs and various preventive therapies for PCP, fungal infections and herpes post transplantation, as indicated is required.
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