HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes.
Improvements in human immunodeficiency virus (HIV)-associated mortality make it difficult to deny transplantation based upon futility. Outcomes in the current management era are unknown. This is a prospective series of liver or kidney transplant recipients with stable HIV disease. Eleven liver and 18 kidney transplant recipients were followed for a median of 3.4 years (IQR [interquartile range] 2.9-4.9). One- and 3-year liver recipients' survival was 91% and 64%, respectively; kidney recipients' survival was 94%. One- and 3-year liver graft survival was 82% and 64%, respectively; kidney graft survival was 83%. Kidney patient and graft survival were similar to the general transplant population, while liver survival was similar to the older population, based on 1999-2004 transplants in the national database. CD4+ T-cell counts and HIV RNA levels were stable; and there were two opportunistic infections (OI). The 1- and 3-year cumulative incidence (95% confidence intervals [CI]) of rejection episodes for kidney recipients was 52% (28-75%) and 70% (48-92%), respectively. Two-thirds of hepatitis C virus (HCV)-infected patients, but no patient with hepatitis B virus (HBV) infection, recurred. Good transplant and HIV-related outcomes among kidney transplant recipients, and reasonable outcomes among liver recipients suggest that transplantation is an option for selected HIV-infected patients cared for at centers with adequate expertise.
Roland
M E
ME
University of California, San Francisco, CA, USA. Michelle.Roland@cDpH.CA.gov
Barin
B
B
Carlson
L
L
Frassetto
L A
LA
Terrault
N A
NA
Hirose
R
R
Freise
C E
CE
Benet
L Z
LZ
Ascher
N L
NL
Roberts
J P
JP
Murphy
B
B
Keller
M J
MJ
Olthoff
K M
KM
Blumberg
E A
EA
Brayman
K L
KL
Bartlett
S T
ST
Davis
C E
CE
McCune
J M
JM
Bredt
B M
BM
Stablein
D M
DM
Stock
P G
PG
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002102:Cadaver; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D016031:Liver Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D019562:Viral Load