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Monday December 24, 11:10 am Eastern Time

Press Release



SOURCE: University of Pittsburgh Medical Center



AIDS Activist Larry Kramer Recovering Following Liver Transplant Surgery; Transplant Brings Focus to Issue of Co-Infection in Patients with HIV



PITTSBURGH, Dec. 24 /PRNewswire/ -- Larry Kramer, acclaimed writer and renowned AIDS activist, underwent liver transplant surgery on Dec. 21 at the University of Pittsburgh Medical Center (UPMC). Kramer, who has human immunodeficiency virus (HIV), needed the life-saving transplant because of end-stage liver failure caused by hepatitis B.



He is in serious condition, which is typical so soon following transplantation. Surgery was 12 hours long and was performed by John Fung, M.D., Ph.D., Ashok Jain, M.D., and Bijan Eghtesad, M.D. Mr. Kramer had waited seven months on the transplant waiting list.



In recent years, UPMC and several other transplant centers have seen the number of transplants in patients like Mr. Kramer increase. Due to the so- called highly active anti-retroviral therapies (HAART), patients with HIV are living longer and developing fewer HIV-related complications. Yet for HIV patients who also have liver disease, such as hepatitis B or hepatitis C, the longer life expectancy may allow progression of their chronic liver disease to end-stage liver failure, and to death without a transplant. Complicating matters is the fact that a failing liver cannot properly metabolize a variety of drugs, such as the anti-retroviral medications for HIV and hepatitis.



``In Larry Kramer's case, his HIV has been relatively well controlled without HAART. However, like many HIV patients with viral hepatitis, his liver disease continued to progress in spite of anti-hepatitis medications,'' stated Dr. Fung, Thomas E. Starzl Professor of Transplantation Surgery and chief, division of transplant surgery, University of Pittsburgh School of Medicine and Thomas E. Starzl Transplantation Institute. ``Our experience with liver transplantation for hepatitis B has been excellent, and the use of new anti- hepatitis B medications should prevent the redevelopment of hepatitis B in Mr. Kramer.''



While most transplant centers consider HIV infection an absolute contraindication to transplantation, UPMC has been one of the few centers in the United States willing to transplant carefully selected HIV-positive patients and has the largest cohort of HIV patients who have received liver or kidney transplants. There is no national policy that states patients with HIV cannot receive transplants.



In general, patients with HIV accepted to UPMC's transplant waiting list have worsening organ function and have had no opportunistic infections characteristic of full-blown Acquired Immune Deficiency Syndrome (AIDS). In addition, the team assesses whether the patient's HIV is likely to be controlled after transplantation and that both anti-rejection and anti-HIV therapies will be tolerated. There are currently five HIV-positive patients on UPMC's liver transplant waiting list.



The University of Pittsburgh is one of 10 centers participating in a National Institutes of Health-funded multi-center trial to determine the safety and effectiveness of liver and kidney transplantation in patients with HIV infection. The outcomes will be useful to the entire transplant and infectious disease community as physicians and surgeons study and define what constitutes the best care for these patients.



The study is being directed by researchers at the University of California, San Francisco. Margaret Ragni, M.D., M.P.H., professor of medicine, University of Pittsburgh School of Medicine, and director of the Hemophilia Center of Western Pennsylvania, is principal investigator of the Pittsburgh site. Dr. Fung is co-principal investigator.



``Like other patients with end-stage organ failure, our HIV patients require transplants to survive. For the most part, results have been good and most of our patients can expect to do well after transplantation. Yet there are still a number of questions that can only be answered through a clinical study involving more patients than those from a single center,'' explained Dr. Fung.



The University of Pittsburgh has the most extensive experience transplanting patients with HIV. Between 1981 and 1988, before anti-retroviral therapy was available, 15 patients who were HIV-positive received transplants at the University of Pittsburgh. (Six had HIV at the time of transplant and nine acquired it at the time of transplant either from blood transfusions or from an infected organ.) While two patients are still alive more than 12 years later, AIDS was the leading cause of death for the other patients due to lack of effective anti-HIV medications.



Since 1997 and the availability of HAART, the University of Pittsburgh has performed 10 liver transplants, six in patients with hemophilia. Kidney transplants have been performed in four patients, all of whom are doing well. Eight of the liver recipients are alive, including a patient with hemophilia transplanted in 1997. According to the United Network for Organ Sharing, 33 liver transplants have been performed since 1988 in the United States. Of the 4,954 liver transplants performed in the United States in 2000, 11 were in patients who were HIV-positive.



About 1 million people in the United States are thought to have HIV or AIDS. At least 300,000 have not been tested and may not even know that they are HIV-positive, according to government estimates. While the rates of hepatitis are increasing among the general population -- nearly 3 million are infected with either hepatitis C or B, no estimates are available for the number of patients with HIV who have co-existing kidney and/or liver disease leading to organ failure. According to some sources, 15 percent of those with HIV have hepatitis C, and among gay men who have HIV, it is estimated that about 40 percent also have hepatitis B.



Rodger McFarlane, Mr. Kramer's primary care giver and former director of Gay Men's Health Crisis (GMHC), America's first and largest AIDS organization, founded by Mr. Kramer, said: ``Transplantation represents a tremendous leap forward in the treatment of AIDS. I commend Dr. Fung, his team and the staff of UPMC for their foresight and courage.''





     CONTACT: Lisa Rossi

              Maureen McGaffin

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SOURCE: University of Pittsburgh Medical Center





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