MELD score is an important predictor of pretransplantation mortality in HIV-infected liver transplant candidates.
OBJECTIVE
Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates.


METHODS
We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing.


RESULTS
Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P < .0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4(+) cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P < .0001).


CONCLUSIONS
Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4(+) cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.
Subramanian
Aruna
A
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. asubra@jhmi.edu
Sulkowski
Mark
M
Barin
Burc
B
Stablein
Donald
D
Curry
Michael
M
Nissen
Nicholas
N
Dove
Lorna
L
Roland
Michelle
M
Florman
Sander
S
Blumberg
Emily
E
Stosor
Valentina
V
Jayaweera
D T
DT
Huprikar
Shirish
S
Fung
John
J
Pruett
Timothy
T
Stock
Peter
P
Ragni
Margaret
M
D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000401:mortality*; D006801:Humans; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000592:standards / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D014850:Waiting Lists