title: Long-term outcomes of orthotopic liver transplantation in human immunodeficiency virus-infected patients and comparison with human immunodeficiency virus-negative cases.
abstract: Human immunodeficiency virus (HIV) positivity is no longer a contraindication for orthotopic liver transplantation (OLT) due to the efficacy of antiretroviral therapy. The aim of this study was to compare OLT among HIV-positive and HIV-negative cohorts; the results were also stratified for hepatitis C virus (HCV) coinfection. Between 2004 and 2009, all HIV-infected patients undergoing OLT from heart-beating deceased donors (n=27) were compared with an HIV-negative cohort (n = 27). The pure HCV infection rate was similar between HIV-positive and HIV-negative subjects (63% each). HIV-positive recipients were younger (P=.013). The CD4 count for HIV-positive subjects was 376 ± 156 at transplantation. The mean model for end-stage liver disease (MELD) score at transplantation was 15 ± 7 in both groups (P=.92). No differences were observed for donor age (P=.72) or time on the waiting list (P=.56). The median follow-up was 26 (range, 1-64) and 27 months (range, 1-48) for HIV and non-HIV recipients, respectively (P=.85). The estimated 1-, 3-, and 5-year patient and graft survival rates were 88%, 83%, and 83% versus 100%, 73%, and 73% (P=.95), and 92%, 87%, and 87% versus 95%, 88%, and 88% (P=.59) for HIV and non-HIV cases, respectively. HIV/HCV-coinfected patients were younger, namely 47 (range, 40-53) versus 52 years (range, 37-68; P=.003), and displayed lower MELD scores at transplantation compared with HCV-mono-infected patients 10 (range, 7-19) versus 17 (range, 8-30) (P=.008). For HIV/HCV-coinfected and HCV-mono-infected cases the estimated 1-, 3-, and 5-year patients and graft survival rates were respectively 93%, 76%, and 76% versus 100%, 70%, and 60% (P=.99) and 93%, 84%, and 84% versus 100%, 70%, and 60% (P=.64), respectively. No difference was observed in the histological severity of HCV recurrence. In conclusion, under specific, well-determined conditions, OLT can be a safe, efficacious procedure in HIV patients.
authors.affiliation: Department of Surgery and Liver Transplantation Unit, University of Udine, Udine, Italy. umberto.baccarani@uniud.it
authors.forename: U
authors.initials: U
authors.lastname: Baccarani
authors.forename: G L
authors.initials: GL
authors.lastname: Adani
authors.forename: F
authors.initials: F
authors.lastname: Bragantini
authors.forename: A
authors.initials: A
authors.lastname: Londero
authors.forename: C
authors.initials: C
authors.lastname: Comuzzi
authors.forename: A
authors.initials: A
authors.lastname: Rossetto
authors.forename: D
authors.initials: D
authors.lastname: Lorenzin
authors.forename: V
authors.initials: V
authors.lastname: Bresadola
authors.forename: A
authors.initials: A
authors.lastname: Risaliti
authors.forename: F
authors.initials: F
authors.lastname: Pea
authors.forename: P
authors.initials: P
authors.lastname: Toniutto
authors.forename: A
authors.initials: A
authors.lastname: Donini
authors.forename: D
authors.initials: D
authors.lastname: De Anna
authors.forename: F
authors.initials: F
authors.lastname: Bresadola
authors.forename: M
authors.initials: M
authors.lastname: Tavio
authors.forename: P
authors.initials: P
authors.lastname: Viale
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome