title: Outcome of patients with hepatitis B virus and human immunodeficiency virus infections referred for liver transplantation.
abstract: The outcome of patients with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) referred for liver transplantation (LT) is unknown. A high frequency of lamivudine-resistant (LAM-R) HBV infection may increase the risk of liver-related death pre-transplantation and prophylaxis failure post-transplantation. We evaluated the association of LAM-R HBV on pre-transplant survival and post-transplant outcomes in 35 consecutive HIV-HBV coinfected patients referred for LT between July 2000 and September 2002. At the time of referral, the median CD4 count was 273/mm, MELD was 14, and LAM-R HBV infection was present in 67%. Among these referred patients, 26% were listed, 29% not listed due to relative/absolute contraindications; 26% not listed as too early for LT; 9% not listed as too sick for LT; and 11% died during transplant evaluation. Of the 9 listed patients, 4 remained listed, 1 died 18 months post-referral, and 4 were transplanted (11% of total) 3 to 40 months after listing. Of 17 evaluated but not listed patients, 5 died (p=0.38 compared to listed group) and all deaths were liver-related. All the HBV-HIV coinfected patients, who were transplanted, are HBsAg negative and have undetectable HBV DNA levels on prophylactic therapy using hepatitis B immune globulin (HBIG) plus lamivudine, with and without tenofovir or adefovir, with median 33.1 months follow-up. Late referral and the presence of LAM-R HBV pre-transplantation are common in referred HIV-HBV patients. In HIV-HBV coinfected patients undergoing LT, HBV recurrence is successfully prevented with combination prophylaxis using HBIG and antivirals.
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, CA 64143-0538, USA. norah.terrault@ucsf.edu
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Carter
authors.forename: Laurie
authors.initials: L
authors.lastname: Carlson
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Roland
authors.forename: Peter G
authors.initials: PG
authors.lastname: Stock
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies
chemical_list: D004279:DNA, Viral