Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jan;138(1):159-64.
doi: 10.1053/j.gastro.2009.09.053. Epub 2009 Sep 30.

MELD score is an important predictor of pretransplantation mortality in HIV-infected liver transplant candidates

Aruna Subramanian  1 , Mark Sulkowski, Burc Barin, Donald Stablein, Michael Curry, Nicholas Nissen, Lorna Dove, Michelle Roland, Sander Florman, Emily Blumberg, Valentina Stosor, D T Jayaweera, Shirish Huprikar, John Fung, Timothy Pruett, Peter Stock, Margaret Ragni
Affiliations

MELD score is an important predictor of pretransplantation mortality in HIV-infected liver transplant candidates

Aruna Subramanian et al. Gastroenterology. 2010 Jan.

Abstract

Background & aims: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates.

Methods: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing.

Results: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P < .0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4(+) cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P < .0001).

Conclusions: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4(+) cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Figure 1a. Time to Death in HIV(+) Transplant Candidates. This Kaplan Meier plot shows that time to death is similar in HIV(+) and HIV(−) transplant candidates., p = 0.18. Figure 1b. Time to Transplantation in HIV(+) Transplant Candidates. This Kaplan Meier plot shows time to transplantation is similar in HIV(+) and HIV(−) transplant candidates, p = 0.13. Figure 1c. Time to MELD ≥ 25 in HIV(+) Transplant Candidates. This Kaplan Meier plot shows the time to elevation of MELD to ≥ 25 is similar in HIV(+) and HIV(−) transplant candidates, p = 0.13.
Figure 1
Figure 1
Figure 1a. Time to Death in HIV(+) Transplant Candidates. This Kaplan Meier plot shows that time to death is similar in HIV(+) and HIV(−) transplant candidates., p = 0.18. Figure 1b. Time to Transplantation in HIV(+) Transplant Candidates. This Kaplan Meier plot shows time to transplantation is similar in HIV(+) and HIV(−) transplant candidates, p = 0.13. Figure 1c. Time to MELD ≥ 25 in HIV(+) Transplant Candidates. This Kaplan Meier plot shows the time to elevation of MELD to ≥ 25 is similar in HIV(+) and HIV(−) transplant candidates, p = 0.13.
See this image and copyright information in PMC

References

    1. Mocroft A, Soriano V, Rockstroh J, et al. Is there evidence for an increase in the death rate from liver-related disease in patients with HIV? AIDS. 2005;19:2117–2125. - PubMed
    1. Weber R, Sabin CA, Friis-Møller N, et al. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006;166:1632–1641. - PubMed
    1. Koziel MJ, Peters MG. Viral hepatitis and HIV infection. N Engl J Med. 2007;356:1445–1454. - PMC - PubMed
    1. Sulkowski MS, Thomas DL, Chaisson RE, et al. Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA. 2000;283:74–80. - PubMed
    1. Sulkowski MS. Viral hepatitis and HIV coinfection. J Hepatol. 2008;48:353–367. - PubMed

Publication types