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

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.