Living Donor Liver Transplantation Using Right Posterior Section Graft in a Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patient With Hemophilia: A Case Report

Abstract

Background

Liver transplantation is an important treatment option for liver cirrhosis in patients with HIV/HCV coinfection. In Japan, the limited number of deceased donors may force the selection of living donor liver transplantation. Appropriate graft selection is the key to success.

Case presentation

The patient, a 66-year-old male with hemophilia A, acquired HIV and HCV through blood transfusions. He had a multidrug-resistant HIV strain, requiring frequent changes in antiretroviral therapy. Although his HCV cleared spontaneously, liver fibrosis progressed. With a Child-Pugh score of 9 and a MELD score of 13, liver transplantation was considered. His child became the living donor. A factor VIII concentrate test was performed preoperatively, and his HIV treatment was adjusted to avoid drug interactions. The chosen graft was a posterior segment (graft-to-recipient weight ratio of 0.8), and surgery lasted 787 min with a blood loss of 7046 g. Factor VIII concentrate was stopped on the second postoperative day as activity increased. The patient was discharged on postoperative day 47.

Conclusion

This is the first reported living donor liver transplantation using a posterior segment graft in a hemophilia patient coinfected with HIV and HCV. Liver transplantation can be safely performed by formulating a preoperative coagulation factor supplementation protocol.