Demand for organs will only increase as the HIV-infected population ages given comorbidities in this population such as hypertension, diabetes mellitus and chronic hepatitis. Second, there has been a tremendous improvement in the understanding and implementation of the prophylaxis of opportunistic infections that afflict both populations of HIV patients as well as patients undergoing transplantation. Finally, there has been increasing proportion of HIV-infected patients with advanced kidney and liver disease, hence an increased demand for organs (3C5). Liver transplantation in the HIV-infected population has been driven mainly by complications of co-infection with hepatitis B (HBV) and hepatitis C virus (HCV), which both share similar modes of transmission as HIV. Liver disease is now a major cause of mortality in HIV-infected individuals. There has also been an increase in demand for kidney transplantation from HIV-associated nephropathy (HIVAN), immunoglobulin (Ig) A nephropathy, and glomerulonephritis as a result of HIV co-infection with HBV and HCV. The initial published reports of outcomes of transplantation in HIV-infected patients came from single patient experiences or case series by single institutions (6, 7). Multiple centers providing retrospective and then prospective studies provided more robust and HIST1H3G generalizable data (8C11). This increasing knowledge base has led to refinements in the way we select HIV-infected patients for transplantation, recommend particular antiretroviral agents, choose immunosuppressive regimens, and anticipate complications in these patients post-transplant. This paper will first review the latest outcomes in liver and kidney transplantation worldwide, focusing on the experiences in the era of highly active antiretroviral therapy (HAART). Then, in keeping with the theme of this issue of emerging infectious disease issues in solid organ transplantation, we will Tenatoprazole review some of the key issues and controversies that have recently arisen in the field. OUTCOMES IN LIVER TRANSPLANTATION Overall survival Summarizing several of the early experiences of transplantation of HIV-infected persons Tenatoprazole since the widespread use of HAART in 1996, a report by the US Scientific Registry of Transplant Recipients (SRTR) described 1-year survival rates in liver transplant recipients from 60C100% (12C15). In the largest experience reported in this document (14), investigators combined data in HIV-infected patients undergoing transplantation from several centers in Pittsburgh, Miami, San Francisco, Tenatoprazole Minneapolis, and London. They then compared outcomes in this group to age and race matched cohort of HIV-uninfected transplant patients from the United Network for Organ Sharing (UNOS). There was no appreciable difference in cumulative survival at 1, 2 and 3 years in the HIV-infected patients (87%, 73%, and 73%) compared to the matched HIV-uninfected patients (87%, 82%, and 78%) (Table 1). Among the HIV-infected patients, lower survival was associated with HCV infection, not being able to tolerate HIV medications post-transplant, and CD4+ T cell counts 200 post-transplant. Although HCV infection was associated with higher mortality in HIV-infected patients, this was not statistically different from survival in the HIV-uninfected HCV-positive controls. Table 1 Rates of Patient and Graft Survival at 1 Year and 3 Years among HIV-infected compared to HIV-uninfected in published multicenter cohort studies. thead th valign=”bottom” align=”remaining” rowspan=”1″ colspan=”1″ /th th valign=”bottom” align=”remaining” rowspan=”1″ colspan=”1″ /th th valign=”bottom” align=”remaining” rowspan=”1″ colspan=”1″ /th th colspan=”4″ valign=”bottom” align=”remaining” rowspan=”1″ Patient survival (%) /th th colspan=”4″ valign=”bottom” align=”remaining” rowspan=”1″ Graft survival (%) /th th valign=”bottom” align=”remaining” rowspan=”1″ colspan=”1″ /th th valign=”bottom” align=”remaining” rowspan=”1″ colspan=”1″ /th th valign=”bottom” align=”remaining” rowspan=”1″ colspan=”1″ /th th valign=”bottom” align=”remaining” rowspan=”1″ colspan=”1″ /th th colspan=”2″ valign=”bottom” align=”remaining” rowspan=”1″ At 1 Year /th th colspan=”2″ valign=”bottom” align=”remaining” rowspan=”1″ At 3 Years /th th colspan=”2″ valign=”bottom” align=”remaining” rowspan=”1″ At 1 Year /th th colspan=”2″ valign=”bottom” align=”remaining” rowspan=”1″ At 3 Years /th th valign=”bottom” align=”remaining” rowspan=”1″ colspan=”1″ /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ Location /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ Organ /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ N (HIV + individuals) /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ HIV+ /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ HIV? /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ HIV+ /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ HIV? /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ HIV+ /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ HIV? /th th valign=”top” Tenatoprazole align=”remaining” rowspan=”1″ colspan=”1″ HIV+ /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ HIV? /th th valign=”top” align=”remaining” rowspan=”1″ colspan=”1″ Research /th /thead USALiver2487877378(14)USALiver (HBV)2285100851008510085100(8)SpainLiver (HCV)848890627686856069(9)USALiver (HCV)897692607972885374(11)USAKidney15095889074(10) Open in a separate window Missing ideals in table not provided in respective studies. Hepatitis B Results in HIV-HBV co-infected individuals are excellent following transplantation. The largest report compared the experience of a prospective cohort of 22 HIV-HBV.