Living donor liver transplant from an HIV-positive mother to her HIV-negative child : opening up new therapeutic options

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.The South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa.http://journals.lww.com/aidsonlineam2019Medical Virolog

Primary repair of a delayed presentation thoracic oesophageal gunshot injury: A report of two cases

Thoracic oesophageal gunshot injuries are uncommon, and the morbidity and mortality rates are extremely high and depend on the elapsed time, injury severity, and concomitant organ damage. Thus, early diagnosis is paramount to avoid delays, which in turn confer poorer outcomes. Current management strategies are still controversial and depend on the patient's physiologic state. We experienced two cases of thoracic oesophageal gunshot injury, both of whom were treated by primary repair and were successfully discharged. Decision-making strategies should be based on the patient's physiologic reserve, experience of the attending surgical team, and ancillary services available at the facility