https://www.ncbi.nlm.nih.gov/pubmed/30281558 Liver transplant

AIDS. 2018 Oct 23;32(16):F13-F19. doi: 10.1097/QAD.0000000000002000.
Living donor liver transplant from an HIV-positive mother to her HIV-negative child: opening up new therapeutic options.

Botha J1, Conradie F2,3, Etheredge H1,3, Fabian J1,3, Duncan M1, Haeri Mazanderani A4,5, Paximadis M4,6, Maher H1, Britz R1, Loveland J1,7, Ströbele B1, Rambarran S1, Mahomed A1,3, Terblanche A1, Beretta M1, Brannigan L1, Pienaar M1, Archibald-Durham L1, Lang A1, Tiemessen CT4,6.

Abstract

OBJECTIVE:
Transplant a liver from an HIV-positive mother to her HIV-negative child to save the child's life.

DESIGN:
A unique case of living donor liver transplantation from an HIV-positive mother to her HIV-negative child in South Africa. Two aspects of this case are ground-breaking. First, it involves living donation by someone who is HIV-positive and second it involves controlled transplant of an organ from an HIV-positive donor into an HIV-negative recipient, with the potential to prevent infection in the recipient.

METHODS:
Standard surgical procedure for living donor liver transplantation at our centre was followed. HIV-prophylaxis was administered preoperatively. Extensive, ultrasensitive HIV testing, over and above standard diagnostic assays, was undertaken to investigate recipient serostatus and is ongoing.

RESULTS:
Both mother and child are well, over 1 year posttransplantation. HIV seroconversion in our recipient was detected with serological testing at day 43 posttransplant. However, a decline in HIV antibody titres approaching undetectable levels is now being observed. No plasma, or cell-associated HIV-1 DNA has been detected in the recipient at any time-point since transplant.

CONCLUSION:
This case potentially opens up a new living liver donor pool which might have clinical relevance in countries where there is a high burden of HIV and a limited number of deceased donor organs or limited access to transplantation. However, our recipient's HIV status is equivocal at present and additional investigation regarding seroconversion events in this unique profile is ongoing.