What Is the Impact of HIV Infection on Survival After Liver Transplantation?

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From Nature Clinical Practice Gastroenterology & Hepatology

What Is the Impact of HIV Infection on Survival After Liver Transplantation?

Posted 08/13/2008

Nyingi Kemmer; E Sherman

Synopsis

Background

HIV infection has not been considered a contraindication to orthotopic liver

transplantation (OLT) since highly active antiretroviral therapy (HAART) became

available in 1997; however, many OLT centers still exclude patients with HIV

infection from OLT because of reported poor outcomes.

Objective

To determine the influence of HIV infection on patient survival after OLT.

Design and Intervention

This US, retrospective study examined data from the United Network for Organ

Sharing (UNOS) database. Patients aged ¡Ý 18 years who had undergone liver

transplantation, or multiple organ transplantation including the liver, between

January 1997 and October 2006 were identified for inclusion in the study.

Exclusion criteria included patients without data on vital or HIV status at the

end of follow-up. Data of eligible patients were extracted from the database for

analysis, which included the evaluation of 19 pre-OLT recipient variables

(including age, co-infection [with HCV or HBV] and model for end-stage liver

disease (MELD) score) and 7 donor variables. Univariate and multivariate

analyses were performed to determine any associations between variables and

outcomes.

Outcome Measure

The main outcome measure was post-OLT survival.

Results

A total 138 OLT recipients with HIV infection and 30,520 OLT recipients without

HIV infection were included in the study. Total follow-up duration for OLT

recipients with and without HIV was 150.55 and 89,845.82 person-years,

respectively. OLT recipients infected with HIV had significantly lower survival

rates than recipients without HIV infection: estimated 2-year and 3-year

survival was 70% versus 81% and 66% versus 77%, respectively (P = 0.04);

however, these differences seemed entirely attributable to the group of OLT

recipients with co-infection (HIV plus HCV or HBV co-infection), as no deaths

occurred during follow-up in recipients with HIV infection only. OLT recipients

co-infected with HIV and HCV had a significantly lower survival rate than OLT

recipients infected with HCV only (P = 0.006). In addition, death rates were

significantly higher in OLT recipients with HIV and HCV co-infection than

recipients with HIV infection only (P = 0.003). Recipients with HBV and HIV

co-infection had a higher rate of death than recipients with HIV infection only,

but this finding was not significant. Regression analysis revealed that OLT

recipients with HIV had a hazard ratio for death of 1.41 (P = 0.14; 95% CI

0.90¨C2.22).

Conclusion

Individuals with HIV infection have good outcomes after OLT; however,

individuals with HIV and HCV co-infection have poor outcomes after OLT that are

significantly poorer than those of individuals infected with HCV or HIV only.