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

Abstract

BACKGROUND Hepatitis C virus (HCV) is a controversial indication for liver transplantation (LT) in HIV-infected patients due to reportedly poor outcomes. METHODS This prospective U.S. multicenter cohort study compared patient and graft survival in 89 HCV-HIV coinfected versus 2 different controls groups: 235 HCV monoinfected LT controls and all U.S. transplant recipients ≥65 years. RESULTS The 3-year patient and graft survival rates (95% CI) were 60% (47–71%) and 53% (40–64%) in HCV-HIV versus 79% (72–84%) and 74% (66–79%) in HCV recipients (both p<0.001) and HIV infection was the only factor significantly associated with reduced patient and graft survival. Among HCV-HIV patients, older donor age (HR=1.3 per decade), combined kidney-LT (HR=3.8), HCV-positive donor (HR=2.5), and body mass index (BMI) less than 21 kg/m2 (HR=3.2) were independent predictors of graft loss. In patients without these latter 3 factors, patient and graft survival were similar to those in U.S. LT recipients. The 3-year incidence of treated acute rejection was 1.6-fold higher in HCV-HIV versus HCV (log rank p=0.02) but cumulative incidence of severe HCV disease (29% versus 23% at 3 years, respectively) were not significantly different (p=0.21). CONCLUSIONS Patient and graft survival are lower in HCV-HIV compared to HCV alone LT patients. Importantly, rates of treated acute rejection but not HCV disease severity are significantly higher in HCV-HIV compared to HCV recipients. Our results indicate that HCV per se is not a contraindication to LT in HIV patients but recipient and donor selection as well as management of acute rejection strongly influence outcomes.

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

“…133 Two prospective studies have shown lower patient survival and higher incidence of acute cellular rejection in HCV and HIV coinfected cohort compared to HCV monoinfected patients. 134,135 FCH and sepsis are the leading causes of death in HCV and HIV coinfected patients. [136][137][138] With the availability of DAA for the treatment of recurrent HCV following liver transplantation, SVR rates have improved in HCV and HIV coinfected patients.…”

An Update on Heart Transplantation in Human Immunodeficiency Virus–Infected Patients

“…Endomyocardial biopsies are performed as in every other transplant patient following local protocols, with a minimum of six biopsies during the first 6 months after transplant and subsequently if clinically indicated. Findings from liver and kidney transplant cohorts seem to confirm that HIVinfected persons are significantly more likely to develop acute rejection than recipients without HIV infection (8,9,33). In fact, most HT recipients with HIV infection listed in Table 2 had rejection episodes.…”

Is liver transplantation feasible in patients coinfected with human immunodeficiency virus and hepatitis C virus?

“…Although our series is limited in number and very select, the 3-year patient survival rate for HIV/HCV-coinfected patients was similar to the 3-year survival rate for HCV-monoinfected patients and higher than the rate for HIV/HCVcoinfected cases in Terrault et al's series. 1 According to our data, HCV coinfection should not be considered a contraindication for LT in HIV-infected patients. In agreement with our North American colleagues, we believe that the key to successful LT in an HIV setting depends on the accurate selection of patients and donors and the intensive management of drug interactions to prevent acute rejection.…”

“…The 3-year incidence of treated acute rejection was 1.6-fold higher for HCV/HIV-coinfected patients versus HCVmonoinfected patients (P ¼ 0.02), but the cumulative rates of severe HCV disease (29% versus 23% at 3 years) were not significantly different (P ¼ 0.21). The authors concluded that HCV per se is not a contraindication for LT in patients with HIV, but the selection of recipients and donors and the management of acute rejection strongly influence outcomes.We would like to comment on the results of Terrault et al 1 and report the outcomes of 32 consecutive HIVinfected patients undergoing LT at our center in Udine, Italy (2004-2010. This study protocol was approved by the institutional review committee of the Italian National Transplant Center.…”