title: Liver transplant outcomes in HIV-infected patients: a systematic review and meta-analysis with synthetic cohort.
abstract: OBJECTIVE
  The relative success of liver transplantation in those with HIV compared to HIV-uninfected individuals remains a point of intense debate. We aimed to evaluate the effectiveness of liver transplantation in HIV-hepatitis co-infected patients using a meta-analysis and individual patient data meta-analysis as a synthetic cohort.
  
  
  METHODS
  We searched MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE (inception to 2010), AMED, CINAHL, TOXNET, Development and Reproductive Toxicology, Hazardous Substances Databank, Psych-info and relevant conferences. We included cohort studies and individual case-reports evaluating survival of co-infected transplant patients. We abstracted data on cohort and case demographics and outcomes. We pooled cohorts using a random-effects analysis and created a synthetic cohort of cases using individual patient data. We confirmed this with the pooled cohort analysis.
  
  
  RESULTS
  We included 15 cohort studies and 49 case series with individual patient data. At 12 months, 84.4% [95% confidence interval (CI) 81.1-87.8%] of patients had survived. Within the HIV-infected population evaluated, HIV-hepatitis B virus (HBV) co-infection was associated with optimal survival. In an adjusted model, individuals positive for HBV were 8.28 (95% CI 2.26-30.33) times more likely to survive when compared to those without HBV. Further, individuals with an undetectable HIV viral load at the time of transplantation were 2.89 (95% CI 1.41-5.91) times more likely to survive when compared to those with detectable HIV viremia. Hepatitis C virus was not a predictor of patient survival when adjusted for by other key predictors [0.54 (95% CI 0.17-1.80)].
authors.affiliation: The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.forename: Steve
authors.initials: S
authors.lastname: Kanters
authors.forename: Marina
authors.initials: M
authors.lastname: Klein
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.forename: Paul
authors.initials: P
authors.lastname: Marotta
authors.forename: Phil
authors.initials: P
authors.lastname: Wong
authors.forename: Norman
authors.initials: N
authors.lastname: Kneteman
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
mesh_terms: D000998:Antiviral Agents; D015331:Cohort Studies; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality / Q000601:surgery; D006526:Hepatitis C / Q000276:immunology* / Q000401:mortality / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents