Survival of human immunodeficiency virus-infected liver transplant recipients.
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.
Ragni
Margaret V
MV
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213-4306, USA. ragni@msx.dept-med.pitt.edu.
Belle
Steven H
SH
Im
KyungAh
K
Neff
Guy
G
Roland
Michelle
M
Stock
Peter
P
Heaton
Nigel
N
Humar
Abhi
A
Fung
John F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000601:surgery* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000254:growth & development*; D016174:Hepacivirus / Q000254:growth & development; D006509:Hepatitis B / Q000150:complications* / Q000821:virology; D006515:Hepatitis B virus / Q000254:growth & development; D006526:Hepatitis C / Q000150:complications / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017093:Liver Failure / Q000150:complications / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D016019:Survival Analysis
D017320:HIV Protease Inhibitors; D007166:Immunosuppressive Agents; D018894:Reverse Transcriptase Inhibitors