Nonviral liver disease is the leading indication for liver transplant in the United States in persons living with human immunodeficiency virus

Abstract

We evaluated whether indications for liver transplantation (LT) have changed among people with/without human immunodeficiency virus (HIV) infection and compared LT outcomes and trends by HIV serostatus. LT recipients (2008-2018) from the United Network for Organ Sharing and Organ Procurement and Transplantation Network (UNOS/OPTN) were identifed. Among 62 195 LT recipients, 352 (0.6%) were HIV-infected. The proportion of HIV-infected patients increased over time (P trend = .001), as did the number of transplant centers performing LT for HIV-infected recipients; average annual percentage change of 9.2% (p < .001). Nonviral causes became the leading indication in 2015 for HIV-uninfected and in 2018 for HIV-infected (P trend < .001). Three-year cumulative patient survival rates were 77.5%, for HIV-infected and 84.6%, for HIV-uninfected (p = .15). Over time, graft and patient survival rates improved for both HIV-infected and uninfected (p < .001). Among HCV-infected LT recipients, 3-year patient survival rates were 72.5% for HIV-infected and 81.8% for HIV-uninfected (p = .02). However, in a subanalysis restricted to 2014-2018, differences in graft and patient survival by HIV serostatus were no longer observed (3-year patient survival rates were 81.2% for HIV-infected and 86.4% for HIV-uninfected, p = .34). In conclusion, in the United States, nonviral liver disease is now the leading indication for LT in HIV-infected patients, and posttransplant outcomes have improved over time.

Keywords: HIV/HCV coinfection, HCV, MELD, NASH, trends, UNOS.

FIGURE 1

(A) Total number of HIV-infected LT recipients over time and number of centers transplanting HIV-infected patients. (B) Total number of HIV-uninfected LT recipients over time. HIV, human inmmunodeficiency virus; LT, liver transplantation

FIGURE 2

(A) Frequency (in columns) and total number (in table) of indications for liver transplantation among HIV-infected adults in the United States. Time trend for HCV (P trend = 0.9), for HBV (P trend = 0.2), and for NASH/ALD/CC (P trend = 0.02). (B) Frequency (in columns) and total number (in table) of indications for liver transplantation among HIV-uninfected adults in the United States. Time trend for HCV (P trend < .001), for HBV (P trend < .001), and for NASH/ALD/CC (P trend < .001). ALD, alcoholic liver disease; CC, cryptogenic cirrhosis; HBV, hepatitis B virus; HCV, hepatitis C virus; NASH, nonalcoholic steatosis liver disease

FIGURE 3

Kaplan–Meier probability of post-liver transplant (LT) graft and patient survival by HIV status overtime. (A) Graft survival. The unadjusted 1- and 3-year graft cumuative survival rates were 85.5% (95%CI, 81.3–88.9) and 73.0% (95%CI, 67.1–78.1), respectively, for the HIV-infected patients and 89.7% (95%CI, 89.4–89.9) and 81.9% (95%CI, 81.5–82.2), respectively, for the HIV-uninfected patients (p = .50 and p = .29). (B) Patient survival. The unadjusted 1- and 3-year cumulative patient survival rates were 87.9% (95%CI, 83.8–91.0) and 77.5% (95%CI, 69.6–80.4), respectively, for the HIV-infected patients and 91.9% (95%CI, 91.7–92.1) and 84.6% (95%CI, 84.2–84.8), respectively, for the HIV-uninfected patients (p = .31 and p = .15). CI, confidence interval; HIV, human inmmunodeficiency virus; LT, liver transplantation