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. 2016 Jan;100(1):141-6.
doi: 10.1097/TP.0000000000000829.

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

Jayme E Locke  1 , Christine Durand, Rhiannon D Reed, Paul A MacLennan, Shikha Mehta, Allan Massie, Anoma Nellore, Derek DuBay, Dorry L Segev
Affiliations

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

Jayme E Locke et al. Transplantation. 2016 Jan.

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.

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Conflict of interest statement

Disclosure: The authors declare no conflicts of interest

Figures

Figure 1
Figure 1
The number of liver transplants performed among the general population and the number of liver transplants performed among HIV+ patients between 2002–2011.
Figure 2
Figure 2
Patient survival among a matched case controlled cohort of HIV+ and HIV− liver transplant recipients. HIV+ recipients were matched 1:10 with HIV− recipients on recipient age, race, BMI, MELD, HCV status, acute rejection; donor age and race, cold ischemia time, and year of transplant. Compared to appropriate matched HIV− controls, patient survival was statistically lower at 5 years [55.8% vs. 72.1%, p < 0.001] and 10 years [39.3% vs. 57.1%, p < 0.001] post–transplant [aHR=1.68; 95% CI=1.28–2.20, p = 0.0002].
Figure 3
Figure 3
Graft survival among a matched case controlled cohort of HIV+ and HIV− liver transplant recipients. HIV+ recipients were matched 1:10 with HIV− recipients on recipient age, race, BMI, MELD, HCV status, acute rejection; donor age and race, cold ischemia time, and year of transplant. Compared to appropriate matched HIV− controls, graft survival was statistically lower at 5 years [51.3% vs. 68.4%, p < 0.001] and 10 years [34.2% vs. 53.7%, p < 0.001] post–transplant [aHR=1.70; 95% CI=1.31–2.20, p < 0.001].
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