Liver Transplantation for a Patient With Hemophilia and HIV/HCV Coinfection Complicated by Pulmonary Hypertension

Liver transplantation for patients with hemophilia and HIV/HCV coinfection presents unique challenges due to the complexity of perioperative management, including coagulation disorders, drug interactions, and potential complications such as pulmonary hypertension. We report a successful case of brain-dead donor liver transplantation in a patient with hemophilia B and HIV/HCV coinfection, complicated by pulmonary hypertension. The patient, a man in his 50s, acquired multidrug-resistant HIV and HCV in childhood from contaminated blood products. Despite successful HCV eradication, liver function declined, and he was listed for transplantation. Preoperative evaluation revealed pulmonary arterial hypertension, which improved with sildenafil citrate, macitentan, and home oxygen therapy. Intraoperatively, coagulation was managed with factor IX supplementation, and circulation remained stable following reperfusion. Postoperatively, immunosuppression, antiretroviral therapy, and treatment for pulmonary hypertension were carefully coordinated to avoid drug interactions. Nitric oxide therapy was utilized to improve oxygenation. The patient was discharged on postoperative day 51 with normal liver function and good overall condition. This case underscores the importance of multidisciplinary collaboration and careful perioperative planning in achieving successful outcomes in liver transplantation for patients with complex comorbidities such as hemophilia, HIV/HCV coinfection, and pulmonary hypertension.