In the previous weeks, and for the first time ever in Italy, a heart transplant was performed on an HIV positive patient. The transplant was performed at the Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) in Palermo. Only a dozen transplants of this kind have ever been performed worldwide. The procedure took place in the scope of the national program implemented in 2002 by the AIDS National Committee and the National Transplant Center.
The patient who underwent this extremely delicate surgery was a man from Northern Italy affected by cardiac failure of ischemic etiology associated to HIV infection. The patient had been assessed a couple of years ago by ISMETT’s multidisciplinary team. It was only in June 2009 however that, having undergone medical therapy and after the worsening of his health conditions, the patient was included on the Istituto’s waiting list. Tests performed confirmed the indication to the heart transplant and full compliance with criteria for waiting list inclusion as provided for by the transplantation experimental program for HIV-infected patients. The surgery was performed given that the experience of similar transplants carried out abroad and in Italy on individuals with HIV infection highlighted a survival rate that overall overlapped that of with no HIV infection. This brought to the decision to perform the intervention.
For this patient, transplant represented the only possibility of survival. His cardiac functions were in fact seriously compromised and his life expectancy was extremely limited. The procedure was performed at the end of August by the team led by Dr. Michele Pilato, Director of ISMETT’s Heart Transplant program. The patient was discharged a few days ago after an extended hospital stay at ISMETT. “The patient’s overall conditions are good”, said Michele Pilato, “He will remain in Palermo for the necessary follow-up that involves complex radiology diagnostic tests every two weeks and then will be able to return home although he’ll remain in direct contact with ISMETT’s physicians.”
The antiretroviral therapy and any potential infectious disease issues were managed by Prof. Paolo Grossi. Grossi, considered one of the leading experts of infectious diseases, is professor of Infectious Diseases at the University of Insubria, infectious diseases coordinator at ISMETT and member of the National Council for Transplants as transplant infectious safety expert. In May 2007, the first double lung transplant ever performed worldwide on an HIV positive patient had taken place at ISMETT. “This heart transplant on an HIV positive individual”, said ISMETT Director, Prof. Bruno Gridelli, “confirms the quality standards reached by ISMETT and our constant commitment to managing complex patients and attracting more and more patients from other Italian regions. Thanks to the use of antiretroviral drugs in the last 10 years we have witnessed an improvement of long-term survival rates for patients with HIV infections. Carrying out a transplant on these patients requires the joint effort of physician and nurse teams with extremely high levels of competence to maintain the balance of the immune system.”
Palermo, October 5, 2009
