Early post‐liver transplant surgical morbidity inHIV‐infected recipients: risk factor for overall survival? A nationwide retrospective study

Abstract

The aim of the study was to analyse the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival (OS) in HIV-infected patients submitted to liver transplantation. Thus a retrospective investigation was conducted on a nationwide multicentre cohort of 157 HIV patients submitted to liver transplantation in six Italian Transplant Units between 2004 and 2014. An early relaparotomy was performed in 24.8% of cases and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%) and suspect of vascular complications(3.8%). No differences in terms of prevalence for either overall or cause-specific early relaparotomies were noted when compared with a non-HIV control group, matched for MELD, recipient age, HCV-RNA positivity and HBV prevalence. While in the control group an early relaparotomy appeared a negative prognostic factor, such impact on OS was not noted in HIV recipients. Nonetheless increasing number of relaparotomies were associated with decreased survival. In multivariate analysis, preoperative refractory ascites and Roux-en-Y choledochojejunostomy reconstruction were significant risk factors for early relaparotomy. To conclude, in HIV liver transplanted patients, an increasing number of early relaparotomies because of surgical complications does negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy are associated with increased risk of early relaparotomy.

miRNA expression profiles in liver grafts of HCV and HIV/HCV‐infected recipients, 6 months after liver transplantation

“…During the 2007-2014 period, 42 HIV/HCV co-infected and 83 HCV mono-infected patients were treated with LT from DBD donors at the Liver Transplant Unit of the University Hospital of Udine. Indications to LT in HIV-infected patients have been already reported elsewhere 7 and did not differ between mono-infected and coinfected cases. Exclusion criteria comprised split liver graft, HBV positivity, coexisting autoimmune hepatitis, post-LT surgical or immunologic complications, treatment with DAA before LT or within 6 months post-LT, unavailability of a specimen of a 6 ± 1 months post-LT protocol liver biopsy, a biopsy core containing less than 11 portal tracts, pathologic features of graft rejection, or cholangiopathy on liver biopsy.…”

Reinfection of Transplanted Livers in HCV- and HCV/HIV-Infected Patients Is Characterized by a Different MicroRNA Expression Profile

“…Specifically, during the 2007–2014 period, 42 HIV/HCV co-infected and 83 HCV mono-infected patients were submitted to liver transplantation (LT) at the Liver Transplant Unit of the University Hospital of Udine. Indications to liver transplantation were identical in HCV mono-infected and HCV/HIV-coinfected patients, as previously reported in [ 1 ]. Exclusion criteria included split liver graft, HBV positivity, coexisting autoimmune hepatitis, post-LT surgical or immunologic complications, treatment with DAA-HCV drugs before LT or within 6 months post-LT, unavailability of a liver biopsy obtained at 6 ± 1 months post-LT, a biopsy core containing less than 11 portal spaces, pathologic features of graft rejection or cholangiopathy on liver biopsy [ 2 ].…”

“…The introduction of both HAART for HIV-1 infection and DAAs against HCV has significantly improved the prognosis of HIV/HCV co-infected patients with ESLD [ 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 ]. However, reinfection of graft is practically inevitable in HCV positive transplanted patients and the presence of co-infection with HIV makes the evolution towards fibrosis more rapid [ 4 ].…”

“…Since the introduction of highly active antiretroviral therapy (HAART), human immunodeficiency virus type 1 (HIV-1) infection is not, anymore, an exclusion criterion for liver transplantation (LT) in patients with a Hepatitis C virus (HCV)-related end stage disease [ 1 , 2 , 3 ]. This latter is the consequence of chronic inflammation, immune activation, and immune senescence due to HCV infection [ 4 , 5 ].…”