Improved long-term outcomes of liver transplantation in patients with HIV

Last Updated: 2015-07-31

By Megan Brooks

NEW YORK (Reuters Health) - Long-term outcomes of liver transplantation have improved markedly over time in patients moninfected with HIV, but not patients coinfected with HIV and hepatitis C virus (HCV), according to a recent study.

Outcomes of liver transplantation "remain concerning" in the population of patients coinfected with HIV and HCV, lead author of the study, Dr. Jayme Locke from the Division of Transplantation at the University of Alabama at Birmingham and colleagues reported online July 14 in the journal Transplantation.

"Monoinfected HIV+ patients with well controlled disease have excellent outcomes after liver transplantation, and those outcomes are similar to uninfected liver transplant recipients," Dr. Locke wrote in an email to Reuters Health. "These results provide additional support for the continued practice of liver transplantation in select HIV-infected end-stage liver disease patients."

Dr. Locke also noted that the number of centers offering liver transplantation for HIV-infected end-stage liver disease patients has increased over the last decade. "Currently, 25% of centers performing liver transplantation in the US offer this life saving therapy to select HIV-infected end-stage liver disease patients," he said.

Using data from the Scientific Registry of Transplant Recipients for the years 2002 to 2011, Dr. Locke and his colleagues compared graft and survival outcomes for 180 HIV-positive liver transplant patients to more than 34,000 HIV-negative matched controls.

Overall, compared to HIV-negative patients, HIV-infected liver transplant recipients had a 1.68-fold increased risk for death (p<0.001) and a 1.70-fold increased risk for graft loss (p<0.001), independent of HCV infection status.

However, in the modern transplant era, after the introduction of integrase-strand transfer inhibitors in 2008, the risk for death and graft loss were similar between HIV monoinfected and HIV-negative liver transplant recipients (adjusted hazard ratio 1.11; p=0.79 and aHR 0.89; p=0.77, respectively).

However, independent of transplant era, HIV-HCV coinfected liver transplant recipients continued to have worse outcomes, namely a greater than twofold increased risk for death (aHR, 2.24; p<0.001) and graft loss (aHR 2.07; p=0.001), compared to recipients with only HCV.

"Studies using national registry data are critical to our understanding of long-term outcomes among HIV+ liver transplant patients and improved access to life saving transplantation for this vulnerable population," Dr. Locke told Reuters Health.

In an interview with Reuters Health, Dr. David Goldberg, Medical Director for Living Donor Liver Transplantation, Hospital of the University of Pennsylvania in Philadelphia, who wasn't involved in the study, noted that this study confirms the findings of other studies in showing that "outcomes of HIV monoinfected patients are really not that different from patients without HIV, and it's really in the coinfected patients that outcomes are not as good."

The question, Dr. Goldberg said, is "how to take these findings and look forward because the field of transplant and hepatitis C and especially hepatitis C and HIV coinfection is rapidly changing."

The study was supported in part by the National Institutes of Health.

SOURCE: http://bit.ly/1SPNn2Y

Transplantation, 2015.