Multicenter expert consensus on perioperative management of liver transplantation in patients with human immunodeficiency virus infection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Dong ^1,2 , TANG Jianxin ^1,2 , WANG Pusen ^1,2 , QUE Weitao ^1,2 , FANG Taishi ^1,2 , HUANG Yiming ^1,2 , ZHANG Yi ^1,2 , HE Yun ^2,3 , WU Qiang ^2,4 , ZHANG Guimei ^2,4 , ZHENG Hong ⁵ , GAO Wei ⁵ , GUO Wenzhi ⁶ , FU Zhiren ⁷ , LI Guangming ⁸ , WANG Shouping ⁹ , KONG Lingxiang ⁹ ,  YANG Jiayin ⁹ ,  ZHONG Lin ^1,2

1. Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, Shenzhen, Guangdong 518112, P. R. China;
2. National Clinical Research Center for Infectious Disease, Shenzhen, Guangdong 518112, P. R. China;
3. Department of Infection and Immunology, Shenzhen Third People’s Hospital, Shenzhen, Guangdong 518112, P. R. China;
4. Department of Anesthesiology, Shenzhen Third People’s Hospital, Shenzhen, Guangdong 518112, P. R. China;
5. Department of Liver Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin 300190, P. R. China;
6. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;
7. Department of General Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P. R. China;
8. Department of Organ Transplantation, You’an Hospital, Capital Medical University, Beijing 100069, P. R. China;
9. Organ Transplant Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

YANG Jiayin, Email: doctoryjy@scu.edu.cn; ZHONG Lin, Email: zhonglin1@medmail.com.cn

Keywords：

human immunodeficiency virus; acquired immunodeficiency syndrome; liver transplantation; perioperative management

DOI：

10.7507/1007-9424.202501066

Video：

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With the widespread adoption of antiretroviral therapy, vast improvements in the life expectancy of individuals infected with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) were seen, and the liver disease of this population has become a leading cause of mortality. Although liver transplantation is as an effective treatment for end-stage liver disease, it remains in its nascent stage for the patients with HIV/AIDS in China, lacking standardized protocols and substantial clinical experience. Therefore, a “Multicenter expert consensus on perioperative management of liver transplantation in patients with human immunodeficiency virus infection” was formulated. This expert consensus aims to standardize and optimize the diagnosis and treatment process for liver transplantation in HIV-infected patients, providing systematic guidance for this procedure in China and fostering multidisciplinary collaboration and development in the field. This expert consensus clearly delineates the indications and contraindications for liver transplantation in HIV-infected patients, emphasizing comprehensive preoperative evaluations of both donors and recipients. These evaluations include infection control measures, immune function monitoring, and management of comorbidities. In terms of surgical procedures, strategies to prevent occupational exposure and intraoperative guidelines are outlined. Postoperatively, the focus is on antiviral therapy, individualized immunosuppression management, and vigilant monitoring of complications to ensure patient recovery and long-term survival. The long-term follow-up management prioritizes regular assessments of liver function, immune status, and HIV-related indicators to adjust treatment plans and enhance patient survival rates and quality of life. With the continuous enrichment of clinical experience and the progress of clinical research, this consensus will be continuously updated.

Citation： ZHAO Dong, TANG Jianxin, WANG Pusen, QUE Weitao, FANG Taishi, HUANG Yiming, ZHANG Yi, HE Yun, WU Qiang, ZHANG Guimei, ZHENG Hong, GAO Wei, GUO Wenzhi, FU Zhiren, LI Guangming, WANG Shouping, KONG Lingxiang, YANG Jiayin, ZHONG Lin. Multicenter expert consensus on perioperative management of liver transplantation in patients with human immunodeficiency virus infection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(1): 9-14. doi: 10.7507/1007-9424.202501066 Copy

1.	Bekker LG, Beyrer C, Mgodi N, et al. HIV infection. Nat Rev Dis Primers, 2023, 9(1): 42. doi: 10.1038/s41572-023-00452-3.
2.	Nkolola JP, Barouch DH. Prophylactic HIV-1 vaccine trials: past, present, and future. Lancet HIV, 2024, 11(2): e117-e124. doi: 10.1016/S2352-3018(23)00264-3.
3.	Board NL, Moskovljevic M, Wu F, et al. Engaging innate immunity in HIV-1 cure strategies. Nat Rev Immunol, 2022, 22(8): 499-512.
4.	Nachega JB, Scarsi KK, Gandhi M, et al. Long-acting antiretrovirals and HIV treatment adherence. Lancet HIV, 2023, 10(5): e332-e342. doi: 10.1016/S2352-3018(23)00051-6.
5.	Kumar RN, Stosor V. Advances in liver transplantation for persons with human immunodeficiency infection. Curr Infect Dis Rep, 2022, 24(3): 39-50.
6.	Tang J, Weng R, Fang T, et al. Clinical outcomes of liver transplantation in human immunodeficiency virus/hepatitis B virus coinfected patients in China. BMC Infect Dis, 2024, 24(1): 383. doi: 10.1186/s12879-024-09284-2.
7.	Tang JX, Zhang KJ, Fang TS, et al. Outcomes of ABO-incompatible liver transplantation in end-stage liver disease patients co-infected with hepatitis B and human immunodeficiency virus. World J Gastroenterol, 2023, 29(11): 1745-1756.
8.	Tang JX, Zhao D. Current status of liver transplantation for human immunodeficiency virus-infected patients in mainland China. World J Gastroenterol, 2024, 30(14): 1958-1962.
9.	Campos-Varela I, Dodge JL, Berenguer M, et al. Temporal trends and outcomes in liver transplantation for recipients with HIV infection in Europe and United States. Transplantation, 2020, 104(10): 2078-2086.
10.	Rossotti R, Merli M, Mazzarelli C, et al. Similar survival but higher and delayed hepatocellular carcinoma recurrence in HIV-positive compared to negative cirrhotics undergoing liver transplantation. Dig Liver Dis, 2023, 55(2): 268-275.
11.	Bonny TS, Kirby C, Martens C, et al. Outcomes of donor-derived superinfection screening in HIV-positive to HIV-positive kidney and liver transplantation: a multicentre, prospective, observational study. Lancet HIV, 2020, 7(9): e611-e619. doi: 10.1016/S2352-3018(20)30200-9.
12.	Dogar AW, Ullah K, Uddin S, et al. Liver transplantation in HIV-infected patient. J Coll Physicians Surg Pak, 2022, 32(12): 1635-1636.
13.	Procaccio F, Masiero L, Vespasiano F, et al. Organ donor screening for carbapenem-resistant gram-negative bacteria in Italian intensive care units: the DRIn study. Am J Transplant, 2020, 20(1): 262-273.
14.	Puri P, Kumar A, Qaleem M. Donor evaluation protocol for live and deceased donors. J Clin Exp Hepatol, 2024, 14(1): 101217. doi: 10.1016/j.jceh.2023.07.004.
15.	Boyarsky BJ, Durand CM, Palella FJ, et al. Challenges and clinical decision-making in HIV-to-HIV transplantation: Insights from the HIV literature. Am J Transplant, 2015, 15(8): 2023-2030.
16.	Di Benedetto F, Di Sandro S, De Ruvo N, et al. Human immunodeficiency virus and liver transplantation: our point of view. Transplant Proc, 2008, 40(6): 1965-1971.
17.	Tateo M, Roque-Afonso AM, Antonini TM, et al. Long-term follow-up of liver transplanted HIV/hepatitis B virus coinfected patients: perfect control of hepatitis B virus replication and absence of mitochondrial toxicity. AIDS, 2009, 23(9): 1069-1076.
18.	Irby JH, Anders ME, Beasley DA, et al. Patient- and family-centered care in the preoperative setting: Simulation cases featuring standardized patients for anesthesia residents. MedEdPORTAL, 2017, 13: 10604. doi: 10.15766/mep_2374-8265.10604.
19.	Owotade FJ, Ogunbodede EO, Sowande OA. HIV/AIDS pandemic and surgical practice in a Nigerian teaching hospital. Trop Doct, 2003, 33(4): 228-231.
20.	Khajeh E, Ramouz A, Aminizadeh E, et al. Comparison of the modified piggyback with standard piggyback and conventional orthotopic liver transplantation techniques: a network meta-analysis. HPB (Oxford), 2023, 25(7): 732-746.
21.	Brustia R, Monsel A, Skurzak S, et al. Guidelines for perioperative care for liver transplantation: Enhanced Recovery After Surgery (ERAS) recommendations. Transplantation, 2022, 106(3): 552-561.
22.	Olson JC, Subramanian R, Karvellas CJ. Intensive care management of liver transplant recipients. Curr Opin Crit Care, 2022, 28(6): 709-714.
23.	Voshavar C. Protease inhibitors for the treatment of HIV/AIDS: Recent advances and future challenges. Curr Top Med Chem, 2019, 19(18): 1571-1598.
24.	Roland ME, Stock PG. Liver transplantation in HIV-infected recipients. Semin Liver Dis, 2006, 26(3): 273-284.
25.	Di Maira T, Little EC, Berenguer M. Immunosuppression in liver transplant. Best Pract Res Clin Gastroenterol, 2020, 46-47: 101681. doi: 10.1016/j.bpg.2020.101681.
26.	Elliot E, Chirwa M, Boffito M. How recent findings on the pharmacokinetics and pharmacodynamics of integrase inhibitors can inform clinical use. Curr Opin Infect Dis, 2017, 30(1): 58-73.
27.	Sparkes T, Manitpisitkul W, Masters B, et al. Impact of antiretroviral regimen on renal transplant outcomes in HIV-infected recipients. Transpl Infect Dis, 2018, 20(6): e12992. doi: 10.1111/tid.12992.
28.	Andersen S, Fichera R, Banks M, et al. Proactive enteral nutrition for patients undergoing allogeneic stem cell transplantation- implementation and clinical outcomes. Eur J Clin Nutr, 2024, 78(3): 251-256.
29.	Craig EV, Heller MT. Complications of liver transplant. Abdom Radiol (NY), 2021, 46(1): 43-67.
30.	European Association for the Study of the Liver. Electronic address: easloffice@easloffice. eu. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol, 2016, 64(2): 433-485.
31.	Buros C, Dave AA, Furlan A. Immediate and late complications after liver transplantation. Radiol Clin North Am, 2023, 61(5): 785-795.
32.	Adam R, Karam V, Delvart V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol, 2012, 57(3): 675-688.
33.	Neuberger J. Follow-up of liver transplant recipients. Best Pract Res Clin Gastroenterol, 2020, 46-47: 101682. doi: 10.1016/j.bpg.2020.101682.

1. Bekker LG, Beyrer C, Mgodi N, et al. HIV infection. Nat Rev Dis Primers, 2023, 9(1): 42. doi: 10.1038/s41572-023-00452-3.
2. Nkolola JP, Barouch DH. Prophylactic HIV-1 vaccine trials: past, present, and future. Lancet HIV, 2024, 11(2): e117-e124. doi: 10.1016/S2352-3018(23)00264-3.
3. Board NL, Moskovljevic M, Wu F, et al. Engaging innate immunity in HIV-1 cure strategies. Nat Rev Immunol, 2022, 22(8): 499-512.
4. Nachega JB, Scarsi KK, Gandhi M, et al. Long-acting antiretrovirals and HIV treatment adherence. Lancet HIV, 2023, 10(5): e332-e342. doi: 10.1016/S2352-3018(23)00051-6.
5. Kumar RN, Stosor V. Advances in liver transplantation for persons with human immunodeficiency infection. Curr Infect Dis Rep, 2022, 24(3): 39-50.
6. Tang J, Weng R, Fang T, et al. Clinical outcomes of liver transplantation in human immunodeficiency virus/hepatitis B virus coinfected patients in China. BMC Infect Dis, 2024, 24(1): 383. doi: 10.1186/s12879-024-09284-2.
7. Tang JX, Zhang KJ, Fang TS, et al. Outcomes of ABO-incompatible liver transplantation in end-stage liver disease patients co-infected with hepatitis B and human immunodeficiency virus. World J Gastroenterol, 2023, 29(11): 1745-1756.
8. Tang JX, Zhao D. Current status of liver transplantation for human immunodeficiency virus-infected patients in mainland China. World J Gastroenterol, 2024, 30(14): 1958-1962.
9. Campos-Varela I, Dodge JL, Berenguer M, et al. Temporal trends and outcomes in liver transplantation for recipients with HIV infection in Europe and United States. Transplantation, 2020, 104(10): 2078-2086.
10. Rossotti R, Merli M, Mazzarelli C, et al. Similar survival but higher and delayed hepatocellular carcinoma recurrence in HIV-positive compared to negative cirrhotics undergoing liver transplantation. Dig Liver Dis, 2023, 55(2): 268-275.
11. Bonny TS, Kirby C, Martens C, et al. Outcomes of donor-derived superinfection screening in HIV-positive to HIV-positive kidney and liver transplantation: a multicentre, prospective, observational study. Lancet HIV, 2020, 7(9): e611-e619. doi: 10.1016/S2352-3018(20)30200-9.
12. Dogar AW, Ullah K, Uddin S, et al. Liver transplantation in HIV-infected patient. J Coll Physicians Surg Pak, 2022, 32(12): 1635-1636.
13. Procaccio F, Masiero L, Vespasiano F, et al. Organ donor screening for carbapenem-resistant gram-negative bacteria in Italian intensive care units: the DRIn study. Am J Transplant, 2020, 20(1): 262-273.
14. Puri P, Kumar A, Qaleem M. Donor evaluation protocol for live and deceased donors. J Clin Exp Hepatol, 2024, 14(1): 101217. doi: 10.1016/j.jceh.2023.07.004.
15. Boyarsky BJ, Durand CM, Palella FJ, et al. Challenges and clinical decision-making in HIV-to-HIV transplantation: Insights from the HIV literature. Am J Transplant, 2015, 15(8): 2023-2030.
16. Di Benedetto F, Di Sandro S, De Ruvo N, et al. Human immunodeficiency virus and liver transplantation: our point of view. Transplant Proc, 2008, 40(6): 1965-1971.
17. Tateo M, Roque-Afonso AM, Antonini TM, et al. Long-term follow-up of liver transplanted HIV/hepatitis B virus coinfected patients: perfect control of hepatitis B virus replication and absence of mitochondrial toxicity. AIDS, 2009, 23(9): 1069-1076.
18. Irby JH, Anders ME, Beasley DA, et al. Patient- and family-centered care in the preoperative setting: Simulation cases featuring standardized patients for anesthesia residents. MedEdPORTAL, 2017, 13: 10604. doi: 10.15766/mep_2374-8265.10604.
19. Owotade FJ, Ogunbodede EO, Sowande OA. HIV/AIDS pandemic and surgical practice in a Nigerian teaching hospital. Trop Doct, 2003, 33(4): 228-231.
20. Khajeh E, Ramouz A, Aminizadeh E, et al. Comparison of the modified piggyback with standard piggyback and conventional orthotopic liver transplantation techniques: a network meta-analysis. HPB (Oxford), 2023, 25(7): 732-746.
21. Brustia R, Monsel A, Skurzak S, et al. Guidelines for perioperative care for liver transplantation: Enhanced Recovery After Surgery (ERAS) recommendations. Transplantation, 2022, 106(3): 552-561.
22. Olson JC, Subramanian R, Karvellas CJ. Intensive care management of liver transplant recipients. Curr Opin Crit Care, 2022, 28(6): 709-714.
23. Voshavar C. Protease inhibitors for the treatment of HIV/AIDS: Recent advances and future challenges. Curr Top Med Chem, 2019, 19(18): 1571-1598.
24. Roland ME, Stock PG. Liver transplantation in HIV-infected recipients. Semin Liver Dis, 2006, 26(3): 273-284.
25. Di Maira T, Little EC, Berenguer M. Immunosuppression in liver transplant. Best Pract Res Clin Gastroenterol, 2020, 46-47: 101681. doi: 10.1016/j.bpg.2020.101681.
26. Elliot E, Chirwa M, Boffito M. How recent findings on the pharmacokinetics and pharmacodynamics of integrase inhibitors can inform clinical use. Curr Opin Infect Dis, 2017, 30(1): 58-73.
27. Sparkes T, Manitpisitkul W, Masters B, et al. Impact of antiretroviral regimen on renal transplant outcomes in HIV-infected recipients. Transpl Infect Dis, 2018, 20(6): e12992. doi: 10.1111/tid.12992.
28. Andersen S, Fichera R, Banks M, et al. Proactive enteral nutrition for patients undergoing allogeneic stem cell transplantation- implementation and clinical outcomes. Eur J Clin Nutr, 2024, 78(3): 251-256.
29. Craig EV, Heller MT. Complications of liver transplant. Abdom Radiol (NY), 2021, 46(1): 43-67.
30. European Association for the Study of the Liver. Electronic address: easloffice@easloffice. eu. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol, 2016, 64(2): 433-485.
31. Buros C, Dave AA, Furlan A. Immediate and late complications after liver transplantation. Radiol Clin North Am, 2023, 61(5): 785-795.
32. Adam R, Karam V, Delvart V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol, 2012, 57(3): 675-688.
33. Neuberger J. Follow-up of liver transplant recipients. Best Pract Res Clin Gastroenterol, 2020, 46-47: 101682. doi: 10.1016/j.bpg.2020.101682.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multicenter expert consensus on perioperative management of liver transplantation in patients with human immunodeficiency virus infection

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