Long-term Outcomes After Liver Transplantation Among Human Immunodeficiency Virus-Infected Recipients.

Academic Article

Abstract

  • BACKGROUND: Early outcomes after human immunodeficiency virus (HIV) + liver transplantation (LT) are encouraging, but data are lacking regarding long-term outcomes and comparisons with matched HIV- patients. METHODS: We examined outcomes among 180 HIV+ LT, and compared outcomes to matched HIV- counterfactuals (Scientific Registry of Transplant Recipients 2002-2011). Iterative expanding radius matching (1:10) on recipient age, race, body mass index, hepatitis C virus (HCV), model for end-stage liver disease score, and acute rejection; and donor age and race, cold ischemia time, and year of transplant. Patient survival and graft survival were estimated using Kaplan-Meier methodology and compared using log-rank and Cox proportional hazards. Subgroup analyses were performed by transplant era (early: 2002-2007 vs. modern: 2008-2011) and HCV infection status. RESULTS: Compared to matched HIV- controls, HIV+ LT recipients had a 1.68-fold increased risk for death (adjusted hazard ratio [aHR], 1.68, 95% confidence interval [95% CI], 1.28-2.20; P < 0.001), and a 1.70-fold increased risk for graft loss (aHR, 1.70; 95% CI, 1.31-2.20; P < 0.001). These differences persisted independent of HCV infection status. However, in the modern transplant era risk for death (aHR, 1.11; 95% CI, 0.52-2.35; P = 0.79) and graft loss (aHR, 0.89; 95% CI, 0.42-1.88; P = 0.77) were similar between monoinfected and uninfected LT recipients. In contrast, independent of transplant era, coinfected LT recipients had increased risk for death (aHR, 2.24; 95% CI, 1.43-3.53; P < 0.001) and graft loss (aHR, 2.07; 95% CI, 1.33-3.22; P = 0.001) compared to HCV+ alone LT recipients. CONCLUSIONS: These results suggest that outcomes among monoinfected HIV+ LT recipients have improved over time. However, outcomes among HIV+ LT recipients coinfected with HCV remain concerning and motivate future survival benefit studies.
  • Published In

  • Transplantation  Journal
  • Keywords

  • Coinfection, End Stage Liver Disease, Female, Graft Survival, HIV Infections, HIV Long-Term Survivors, Hepatitis C, Humans, Kaplan-Meier Estimate, Liver Transplantation, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Proportional Hazards Models, Registries, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, United States
  • Digital Object Identifier (doi)

    Author List

  • Locke JE; Durand C; Reed RD; MacLennan PA; Mehta S; Massie A; Nellore A; DuBay D; Segev DL
  • Start Page

  • 141
  • End Page

  • 146
  • Volume

  • 100
  • Issue

  • 1