Before the advent of highly active antiretroviral treatment (HAART) in 1996, poor outcome following liver transplantation (LT) in patients infected with human immunodeficiency virus type 1 (HIV) (1) led experts to consider HIV infection a formal contraindication for this procedure (2). However, several authors showed that HAART was able to control HIV infection after LT (3–6). Despite this success, some recent single-center reports have described reduced long-term survival after LT in patients coinfected by HIV and hepatitis C virus (HCV), mainly due to recurrence of HCV infection (7,8). Moreover, the recently published results of ongoing nationwide prospective studies conducted in Spain (funded by the Spanish Foundation for AIDS Research and Prevention [FIPSE]) and in the United States (Transplant Study for People with HIV funded by the National Institutes of Health) show that survival after LT in HIV/HCV-coinfected patients is shorter than in HIV-negative matched controls (9,10).
The frequency of liver retransplantation (reLT) in HIV-negative patients has ranged from 6.5% to 13.4% in recent years. The most common reasons for emergency reLT are primary graft nonfunction (PNF) and vascular thrombosis; the most common reasons for elective reLT are disease recurrence and chronic rejection (11–14). Overall survival after reLT is 15–20% lower than that of primary transplant recipients (11,15,16), and the marked disparity between the number of patients awaiting their first LT and the scarcity of available organs gives cause for concern. HIV-infected recipients and HIV-negative recipients can suffer from the same complications after LT (graft dysfunction, vascular thrombosis and recurrence of liver disease), and these could eventually lead to reLT. However, published experience with reLT in HIV-infected patients is scant, and most cases are only mentioned in articles reporting single-center experiences after primary transplantation in HIV-infected patients (5,7,17–22). Consequently, the incidence and outcome of reLT in HIV-infected patients is unknown, and, since the benefit of primary LT in HIV-infected patients remains open to debate, the usefulness of reLT in this population may be even more controversial. Therefore, we describe the incidence, indications, main characteristics and outcome of reLT in HIV-infected patients included in the aforementioned Spanish prospective FIPSE study. In addition, we compare survival of reLT in HIV-infected patients with that of matched HIV-negative controls.