Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection

Abstract

Hepatitis C virus (HCV) is a controversial indication for liver transplantation (LT) in human immunodeficiency virus (HIV)-infected patients because of reportedly poor outcomes. This prospective, multicenter US cohort study compared patient and graft survival for 89 HCV/HIV-coinfected patients and 2 control groups: 235 HCV-monoinfected LT controls and all US transplant recipients who were 65 years old or older. The 3-year patient and graft survival rates were 60% [95% confidence interval (CI) = 47%-71%] and 53% (95% CI = 40%-64%) for the HCV/HIV patients and 79% (95% CI = 72%-84%) and 74% (95% CI = 66%-79%) for the HCV-infected recipients (P < 0.001 for both), and HIV infection was the only factor significantly associated with reduced patient and graft survival. Among the HCV/HIV patients, older donor age [hazard ratio (HR) = 1.3 per decade], combined kidney-liver transplantation (HR = 3.8), an anti-HCV-positive donor (HR = 2.5), and a body mass index < 21 kg/m(2) (HR = 3.2) were independent predictors of graft loss. For the patients without the last 3 factors, the patient and graft survival rates were similar to those for US LT recipients. The 3-year incidence of treated acute rejection was 1.6-fold higher for the HCV/HIV patients versus the HCV patients (39% versus 24%, log rank P = 0.02), but the cumulative rates of severe HCV disease at 3 years were not significantly different (29% versus 23%, P = 0.21). In conclusion, patient and graft survival rates are lower for HCV/HIV-coinfected LT patients versus HCV-monoinfected LT patients. Importantly, the rates of treated acute rejection (but not the rates of HCV disease severity) are significantly higher for HCV/HIV-coinfected recipients versus HCV-infected recipients. Our results indicate that HCV per se is not a contraindication to LT in HIV patients, but recipient and donor selection and the management of acute rejection strongly influence outcomes.

Figure 1

1A: Kaplan–Meier Estimates of Patient Survival in HCV-HIV and HCV Liver Transplant Recipients The 1 and 3 year patient survival rates (95% CI) were 76% (66–84%) and 60% (47–71%) in HCV-HIV, and 92% (87–95%) and 79% (72–84%) in HCV (p<0.001). 1B: Kaplan–Meier Estimates of Graft Survival in HCV-HIV and HCV Liver Transplant Recipients The 1 and 3 year graft survival rates (95% CI) were 72% (61–80%) and 53% (40–64%) in HCV-HIV, and 88% (83–91%) and 74% (66–79%) in HCV (p<0.001). The rate of graft survival was calculated on the basis of graft failure from any cause. 1C/D: Kaplan–Meier Estimates of Patient and Graft Survival in HCV-HIV Coinfected Liver Transplant Recipients by Risk Group HCV-HIV coinfected liver transplant recipients were divided into two risk groups: 25 subjects who were identified to have an increased risk of graft loss (enrollment BMI < 21, or combined kidney-liver transplant, or anti-HCV positive donor were included in the High Risk group; remaining 64 subjects were included in the non-High Risk group. The 1- and 3-year patient survival rates (95% CI) were 86% (75–93%) and 72% (56–83%) in non-High Risk HCV-HIV, and 51% (30–68%) and 29% (9–52%) in High Risk HCV-HIV patients (p<0.001). The 1- and 3-year graft survival rates (95% CI) were 84% (72–91%) and 65% (49–77%) in non-High Risk HCV-HIV, and 42% (23–61%) and 20% (5–43%) in High Risk HCV-HIV patients (p<0.001). However, rates of patient survival (1C) and graft survival (1D) in non-High Risk HCV-HIV group were similar to those rates reported in the national Scientific Registry of Transplant Recipients (SRTR) for older liver-transplant recipients (≥65 years) and for all liver-transplant recipients in the United States during a similar time frame. The rate of graft survival was calculated on the basis of graft failure from any cause.

Figure 1

1A: Kaplan–Meier Estimates of Patient Survival in HCV-HIV and HCV Liver Transplant Recipients The 1 and 3 year patient survival rates (95% CI) were 76% (66–84%) and 60% (47–71%) in HCV-HIV, and 92% (87–95%) and 79% (72–84%) in HCV (p<0.001). 1B: Kaplan–Meier Estimates of Graft Survival in HCV-HIV and HCV Liver Transplant Recipients The 1 and 3 year graft survival rates (95% CI) were 72% (61–80%) and 53% (40–64%) in HCV-HIV, and 88% (83–91%) and 74% (66–79%) in HCV (p<0.001). The rate of graft survival was calculated on the basis of graft failure from any cause. 1C/D: Kaplan–Meier Estimates of Patient and Graft Survival in HCV-HIV Coinfected Liver Transplant Recipients by Risk Group HCV-HIV coinfected liver transplant recipients were divided into two risk groups: 25 subjects who were identified to have an increased risk of graft loss (enrollment BMI < 21, or combined kidney-liver transplant, or anti-HCV positive donor were included in the High Risk group; remaining 64 subjects were included in the non-High Risk group. The 1- and 3-year patient survival rates (95% CI) were 86% (75–93%) and 72% (56–83%) in non-High Risk HCV-HIV, and 51% (30–68%) and 29% (9–52%) in High Risk HCV-HIV patients (p<0.001). The 1- and 3-year graft survival rates (95% CI) were 84% (72–91%) and 65% (49–77%) in non-High Risk HCV-HIV, and 42% (23–61%) and 20% (5–43%) in High Risk HCV-HIV patients (p<0.001). However, rates of patient survival (1C) and graft survival (1D) in non-High Risk HCV-HIV group were similar to those rates reported in the national Scientific Registry of Transplant Recipients (SRTR) for older liver-transplant recipients (≥65 years) and for all liver-transplant recipients in the United States during a similar time frame. The rate of graft survival was calculated on the basis of graft failure from any cause.

Figure 1

1A: Kaplan–Meier Estimates of Patient Survival in HCV-HIV and HCV Liver Transplant Recipients The 1 and 3 year patient survival rates (95% CI) were 76% (66–84%) and 60% (47–71%) in HCV-HIV, and 92% (87–95%) and 79% (72–84%) in HCV (p<0.001). 1B: Kaplan–Meier Estimates of Graft Survival in HCV-HIV and HCV Liver Transplant Recipients The 1 and 3 year graft survival rates (95% CI) were 72% (61–80%) and 53% (40–64%) in HCV-HIV, and 88% (83–91%) and 74% (66–79%) in HCV (p<0.001). The rate of graft survival was calculated on the basis of graft failure from any cause. 1C/D: Kaplan–Meier Estimates of Patient and Graft Survival in HCV-HIV Coinfected Liver Transplant Recipients by Risk Group HCV-HIV coinfected liver transplant recipients were divided into two risk groups: 25 subjects who were identified to have an increased risk of graft loss (enrollment BMI < 21, or combined kidney-liver transplant, or anti-HCV positive donor were included in the High Risk group; remaining 64 subjects were included in the non-High Risk group. The 1- and 3-year patient survival rates (95% CI) were 86% (75–93%) and 72% (56–83%) in non-High Risk HCV-HIV, and 51% (30–68%) and 29% (9–52%) in High Risk HCV-HIV patients (p<0.001). The 1- and 3-year graft survival rates (95% CI) were 84% (72–91%) and 65% (49–77%) in non-High Risk HCV-HIV, and 42% (23–61%) and 20% (5–43%) in High Risk HCV-HIV patients (p<0.001). However, rates of patient survival (1C) and graft survival (1D) in non-High Risk HCV-HIV group were similar to those rates reported in the national Scientific Registry of Transplant Recipients (SRTR) for older liver-transplant recipients (≥65 years) and for all liver-transplant recipients in the United States during a similar time frame. The rate of graft survival was calculated on the basis of graft failure from any cause.

Figure 1

1A: Kaplan–Meier Estimates of Patient Survival in HCV-HIV and HCV Liver Transplant Recipients The 1 and 3 year patient survival rates (95% CI) were 76% (66–84%) and 60% (47–71%) in HCV-HIV, and 92% (87–95%) and 79% (72–84%) in HCV (p<0.001). 1B: Kaplan–Meier Estimates of Graft Survival in HCV-HIV and HCV Liver Transplant Recipients The 1 and 3 year graft survival rates (95% CI) were 72% (61–80%) and 53% (40–64%) in HCV-HIV, and 88% (83–91%) and 74% (66–79%) in HCV (p<0.001). The rate of graft survival was calculated on the basis of graft failure from any cause. 1C/D: Kaplan–Meier Estimates of Patient and Graft Survival in HCV-HIV Coinfected Liver Transplant Recipients by Risk Group HCV-HIV coinfected liver transplant recipients were divided into two risk groups: 25 subjects who were identified to have an increased risk of graft loss (enrollment BMI < 21, or combined kidney-liver transplant, or anti-HCV positive donor were included in the High Risk group; remaining 64 subjects were included in the non-High Risk group. The 1- and 3-year patient survival rates (95% CI) were 86% (75–93%) and 72% (56–83%) in non-High Risk HCV-HIV, and 51% (30–68%) and 29% (9–52%) in High Risk HCV-HIV patients (p<0.001). The 1- and 3-year graft survival rates (95% CI) were 84% (72–91%) and 65% (49–77%) in non-High Risk HCV-HIV, and 42% (23–61%) and 20% (5–43%) in High Risk HCV-HIV patients (p<0.001). However, rates of patient survival (1C) and graft survival (1D) in non-High Risk HCV-HIV group were similar to those rates reported in the national Scientific Registry of Transplant Recipients (SRTR) for older liver-transplant recipients (≥65 years) and for all liver-transplant recipients in the United States during a similar time frame. The rate of graft survival was calculated on the basis of graft failure from any cause.