Survival of Human Immunodeficiency Virus–Infected Liver Transplant Recipients

Abstract

Human immunodeficiency virus (HIV) infection has been considered an absolute contraindication to solid-organ transplantation. With immune function restoration possible with highly active antiretroviral therapy (HAART), we evaluated 24 HIV-positive subjects with end-stage liver disease who were undergoing orthotopic liver transplantation (OLTX) after the availability of HAART. The cumulative survival among HIV-positive recipients was similar to that among age- and race-comparable HIV-negative recipients (P=.365, by log-rank test). At 12, 24, and 36 months after OLTX, survival was, respectively, 87.1%, 72.8%, and 72.8% among HIV-positive patients, versus 86.6%, 81.6%, and 77.9% among HIV-negative patients. Survival was poorer among subjects with post-OLTX antiretroviral intolerance (P=.044), a post-OLTX CD4(+) cell count of <200 cells/microL (P=.005), a post-OLTX HIV load of >400 copies/mL (P=.016), and hepatitis C virus infection (P=.023). These findings suggest that survival of HIV-positive liver transplant recipients does not differ from that of HIV-negative liver transplant recipients, and they suggest that HIV infection should no longer be a contraindication to OLTX. Further prospective studies are warranted.

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

“…131 HIV infection had no impact on recurrence of hepatocellular carcinoma (HCC) or survival after liver transplantation. In a recent Spanish study in HIV-infected patients undergoing liver transplantation for HCC, Aguero et al 132 found that survival at 1, 3, and 5 years for HIVinfected versus non-HIV-infected patients was 88% versus 90%, 78% versus 78%, and 67% versus 73% (P = 0.779), respectively.…”

Liver transplantation in HIV-positive patients: the position of the Brazilian groups

“…Indeed, the publication of the largest series evaluating the results of the procedure in patients with HIV infection using HAART are recent, the number of cases included is small, and the follow-up time is short (10,21,22,29) . For example, a multicenter study involving major transplanting centers (Pittsburgh, Miami, San Francisco, Minneapolis and London), published in 2003, evaluated 24 patients, with mean follow-up of 17 months (27) . However, occasionally, results of studies with a limited number of patients have a considerable impact and have been used as guides for conduct.…”

La transplantation hépatique chez les patients co-infectés VIH/VHC et VIH/VHB

“…Dans la période suivant la greffe, deux problèmes majeurs surviennent représentés d'une part par la toxicité des antirétroviraux, et d'autre part la récidive virale C sur le greffon (Tableau I) [14][15][16][17][18][19][20][21][22]. Récidive virale C : n = 6 (M49, M14, M9, M11, M13, M4) Récidive virale C et rejet chronique : n = 1 (M20) Défaillance multiviscérale : n = 2 (S1, S2) Récidive carcinome hépatocellulaire : n = 1 (M12) Sepsis : n = 3 (M2, M3, M6) Tableau I. Principales expériences de transplantation hépatique chez les patients co-infectés par le VIH dans la littérature.…”

“…Il n'y a pas d'éléments dans notre série ou dans celles de la littérature pour suggérer une accélération de la maladie VIH après la transplantation hépatique [15,16]. Le chiffre absolu de CD4 reste stable ou augmente après la transplantation.…”

“…Dans une étude menée par le même groupe, la survie était influencée par la toxicité des antirétroviraux, un taux de CD4 après greffe inférieur à 200 cellules/μl et une charge virale VIH post-transplantation supérieure à 400 copies/ml [26]. Dans notre expérience, la survie des patients co-infectés VIH/VHC à 2 ans est de 70 % et le seul facteur pronostic influençant la survie est le score MELD calculé avant greffe (Figure 3).…”