Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection.
Hepatitis C virus (HCV) is a controversial indication for liver transplantation (LT) in human immunodeficiency virus (HIV)-infected patients because of reportedly poor outcomes. This prospective, multicenter US cohort study compared patient and graft survival for 89 HCV/HIV-coinfected patients and 2 control groups: 235 HCV-monoinfected LT controls and all US transplant recipients who were 65 years old or older. The 3-year patient and graft survival rates were 60% [95% confidence interval (CI) = 47%-71%] and 53% (95% CI = 40%-64%) for the HCV/HIV patients and 79% (95% CI = 72%-84%) and 74% (95% CI = 66%-79%) for the HCV-infected recipients (P < 0.001 for both), and HIV infection was the only factor significantly associated with reduced patient and graft survival. Among the HCV/HIV patients, older donor age [hazard ratio (HR) = 1.3 per decade], combined kidney-liver transplantation (HR = 3.8), an anti-HCV-positive donor (HR = 2.5), and a body mass index < 21 kg/m(2) (HR = 3.2) were independent predictors of graft loss. For the patients without the last 3 factors, the patient and graft survival rates were similar to those for US LT recipients. The 3-year incidence of treated acute rejection was 1.6-fold higher for the HCV/HIV patients versus the HCV patients (39% versus 24%, log rank P = 0.02), but the cumulative rates of severe HCV disease at 3 years were not significantly different (29% versus 23%, P = 0.21). In conclusion, patient and graft survival rates are lower for HCV/HIV-coinfected LT patients versus HCV-monoinfected LT patients. Importantly, the rates of treated acute rejection (but not the rates of HCV disease severity) are significantly higher for HCV/HIV-coinfected recipients versus HCV-infected recipients. Our results indicate that HCV per se is not a contraindication to LT in HIV patients, but recipient and donor selection and the management of acute rejection strongly influence outcomes.
University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA. norah.terrault@ucsf.edu
Norah A
NA
Terrault
Michelle E
ME
Roland
Thomas
T
Schiano
Lorna
L
Dove
Michael T
MT
Wong
Fred
F
Poordad
Margaret V
MV
Ragni
Burc
B
Barin
David
D
Simon
Kim M
KM
Olthoff
Lynt
L
Johnson
Valentina
V
Stosor
Dushyantha
D
Jayaweera
John
J
Fung
Kenneth E
KE
Sherman
Aruna
A
Subramanian
J Michael
JM
Millis
Douglas
D
Slakey
Carl L
CL
Berg
Laurie
L
Carlson
Linda
L
Ferrell
Donald M
DM
Stablein
Jonah
J
Odim
Lawrence
L
Fox
Peter G
PG
Stock
D000006:Abdomen, Acute; D000328:Adult; D060085:Coinfection / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D015658:HIV Infections / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000401:mortality*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000401:mortality; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology