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 HIVpositive
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.
