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Man with HIV gets new liver

Prominent patient draws international attention

Tuesday, December 25, 2001

By Christopher Snowbeck, Post-Gazette Staff Writer

In the most high-profile case to date of an HIV-positive patient receiving an organ transplant, author and activist Larry Kramer underwent liver transplant surgery Friday at UPMC Presbyterian.

Yesterday, the 66-year-old Kramer was listed in serious condition -- typical for transplant patients this soon after surgery -- and doctors said he could be released from the intensive care unit by tomorrow.

After gaining recognition as a screenwriter and novelist in the 1960s and 1970s, Kramer helped found the activist groups Gay Men's Health Crisis and Act-Up in the 1980s.

Jeff Getty, an activist with Survive AIDS in California, yesterday said Kramer's post-transplant health could be significant in two ways: It could persuade more hospitals to offer transplants to HIV patients and it could encourage health plans to cover transplant costs.

"Our group is extremely happy about this because we have been working on trying to get access to organ transplants for nearly four years. We knew someone like Larry Kramer getting a liver transplant would lead to worldwide attention, so we're on pins and needles," Getty said. "We see this as an important turning point in changing consciousness."

Historically, patients infected with the human immunodeficiency virus were not eligible for transplants because they almost always developed AIDS and died. In the 1980s, for example, the University of Pittsburgh transplanted 15 HIV-positive patients, but many died due to the lack of effective anti-HIV drugs.

When newer medicines in the late 1990s helped transform AIDS into more of a chronic disease, UPMC was a leader in performing a few transplants on an experimental basis.

Since 1997, UPMC has performed 10 liver transplants on patients with HIV. Eight are still alive, including one who was transplanted in 1997. The United Network for Organ Sharing has recorded 33 liver transplants in HIV-positive patients across the county since 1988, although the Virginia-based group says the numbers might be incomplete because of confidentiality laws in some states.

Of the 33 counted by UNOS, 11 were performed last year. That was a small fraction of the 4,594 liver transplants performed in the United States in 2000.

Kramer's 12-hour surgery on Friday was performed by a team led by Dr. John Fung, chief of transplant surgery at the University of Pittsburgh School of Medicine.

"He's doing very well," said surgeon Dr. Bijan Eghtesad. "The liver is functioning fine. Everything is going in the right direction."

Friend and caregiver Rodger McFarlane said Kramer was off a ventilator within 24 hours of surgery and was cogent by early yesterday morning. During the day, Kramer met with a physical therapist, sat up in a chair and smiled as his partner read e-mails from friends, McFarlane said.

Kramer needed a transplant to cure liver disease caused by hepatitis B. But to keep the transplanted liver, he must take anti-rejection drugs that suppress his immune system, reducing the number of disease-fighting T-cells in particular. As a result, Kramer must take drugs known as high active anti-retroviral therapies or HAART to fight HIV.

Before immunosuppression, Kramer's T-cell count had never dipped below 200 cells per microliter of blood, the point at which an HIV infection becomes AIDS.

"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," Fung said in a statement. "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."

UPMC is one of 10 centers participating in a National Institutes of Health-funded trial to determine the safety and effectiveness of liver and kidney transplantation in patients with HIV infection. There are currently five HIV-positive patients on UPMC's liver transplant waiting list.

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