Impact of human immunodeficiency virus on survival after liver transplantation: analysis of United Network for Organ Sharing database.
BACKGROUND
The outcome of liver transplantation (LT) in patients infected with human immunodeficiency virus (HIV) has been a matter of controversy.


METHODS
A retrospective cohort study was performed to assess the impact of HIV on LT survival by using United Network for Organ Sharing registry Standard Transplant Analysis and Research files.


RESULTS
A total of 138 HIV(+) and 30,520 HIV(-) patients who were > or =18 years old and underwent LT during the highly active antiretroviral therapy era (starting January 1, 1997) in the United States were included. Among all HIV(+) patients, the estimated 2-year survival probability was lower (70%) than among non-HIV patients (81%). This excess risk appeared entirely among those with coinfections, that is, HIV with hepatitis B virus or hepatitis C virus (HCV), as none of the 24 HIV-infected patients who did not have hepatitis B virus or HCV died during an average of 1.2 years of follow-up per person. Among HCV(+) patients, those with HIV coinfection had significantly lower survival rates than patients without HIV (P=0.006). Controlling for age, coinfection, Model for End-Stage Liver Disease scores, and other potential confounders in a proportional hazards regression analysis, HIV(+) patients had a hazard ratio of 1.41 (P=0.14, 95% confidence interval: 0.90-2.22) for mortality after LT.


CONCLUSIONS
HIV(+) patients without HCV coinfection seemed to have good prognosis, whereas patients who had HIV/HCV coinfection had poor outcomes, which were significantly worse than that seen in those with HCV alone.
Mindikoglu
Ayse L
AL
Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201-1595, USA. amindiko@medicine.umaryland.edu
Regev
Arie
A
Magder
Laurence S
LS
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000601:surgery / Q000821:virology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018070:Biological Specimen Banks / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006678:HIV / Q000502:physiology*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012307:Risk Factors; D015996:Survival Rate