Beyond the NIH Multicenter HIV Transplant Trial Experience: Outcomes of HIV+ Liver Transplant Recipients Compared to HCV+ or HIV+/HCV+ Coinfected Recipients in the United States.

نویسندگان

  • Deirdre Sawinski
  • David S Goldberg
  • Emily Blumberg
  • Peter L Abt
  • Roy D Bloom
  • Kimberly A Forde
چکیده

BACKGROUND The effectiveness of liver transplant (LT) in human immunodeficiency virus (HIV) and HIV/hepatitis C virus (HCV) coinfected recipients in the United States is unknown. We investigated (i) the effect of HIV on US patient and allograft LT outcomes, compared to HCV+ and HIV/HCV uninfected recipients and (ii) whether LT at centers that participated in the National Institutes of Health (NIH) Solid Organ Transplantation in HIV Trial, reflecting experience and a standardized approach to patient selection, impacted outcomes. METHODS A retrospective cohort study of primary LT recipients transplanted 27 February 2002 through 31 December 2013, categorized by serostatus: HCV+ (n = 20 829), HIV+ (n = 72), HIV+/HCV+ (n = 160), and HIV-/HCV- uninfected (n = 22 926) as reference. Survival was determined using Cox regression, stratified according to center NIH trial participation. RESULTS HCV (hazard ratio [HR] 1.46, 95% confidence interval [CI], 1.41-1.52) and HIV/HCV coinfection (HR 2.62, 95% CI, 2.06-3.33) were associated with mortality; HIV monoinfection was not (HR 1.37, 95% CI, .86-2.18). This was unchanged after stratification on NIH trial participation, although mortality was higher in NIH-enrolling (HIV+: HR 1.65, 95% CI, .93-2.92; HIV+/HCV+: HR 3.15, 95% CI, 2.32-4.28) than in non-enrolling centers (HIV+: HR 1.03, 95% CI, .43-2.47, HIV+/HCV+: HR 2.55, 95% CI, 1.64-3.96). Although allograft loss was higher in HIV/HCV coinfected recipients transplanted at enrolling (HR 2.64, 9%% CI, 1.91-3.64) vs nonenrolling centers (HR 2.22, 95% CI, 1.41-3.49), there was no difference in HIV and HCV monoinfected patients. CONCLUSIONS HIV+ LT recipient outcomes were superior to HCV+ or HIV/HCV coinfected recipients. Despite a standardized approach and plausibly more experience with HIV patients, transplantation at NIH study center did not improve outcomes.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

A National Study of Outcomes among HIV-Infected Kidney Transplant Recipients.

Kidney transplantation is a viable treatment for select patients with HIV and ESRD, but data are lacking regarding long-term outcomes and comparisons with appropriately matched HIV-negative patients. We analyzed data from the Scientific Registry of Transplant Recipients (SRTR; 2002-2011): 510 adult kidney transplant recipients with HIV (median follow-up, 3.8 years) matched 1:10 to HIV-negative ...

متن کامل

HIV infection and renal transplantation.

BACKGROUND Some aspects of kidney transplant outcome in human immunodeficiency virus (HIV)-infected patients are still controversial. Besides, published experience is scarce in Europe. METHODS A multicentre case-control study was designed to analyse the outcome of renal transplant in HIV + patients in Spain. Twenty HIV + patients were compared with a matched cohort of 40 HIV - recipients. R...

متن کامل

Superior outcomes in HIV-positive kidney transplant patients compared to HCV-infected or HIV/HCV co-infected recipients

The prerequisite for an 'undetectable' HIV viral load has restricted access to transplantation for HIV-infected kidney recipients. However, HCV-infected recipients, owing to the historic limitations of HCV therapy in patients with renal disease, are commonly viremic at transplant and have universal access. To compare the effect of HIV, HCV, and HIV/HCV coinfection on kidney transplant patient a...

متن کامل

Infections in solid organ transplantation in special situations: HIV-infection and immigration.

With the advent of highly active antiretroviral therapy in 1996, patients infected with HIV are now living longer and are dying from illnesses other than acquired immunodeficiency syndrome (AIDS). Liver disease due to chronic hepatitis C is now a leading cause of mortality among HIV-infected patients in the developed world. The prevalence of end-stage kidney or heart disease is also increasing ...

متن کامل

[Comprehensive guidelines translate research findings into clinical policy for HIV-infected transplant candidates and recipients].

questions remain. Encouraging preliminary studies have been small and of relatively short duration. In addition, we have observed an unusually high incidence of rejection among our kidney transplant recipients that remains unexplained. Finally, the outcomes of HCV co-infected liver transplant recipients have been mixed, and several cases of rapid and severe recurrent HCV have been reported. As ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

دوره 61 7  شماره 

صفحات  -

تاریخ انتشار 2015